Emphysematous Pyelonephritis with Abscesses Masquerading as an Ordinary Urinary Tract Infection
Tasnim F. Imran, Frederick Yick, Ahmed H. Qavi, Sundar Dhamotharan and Steven J. Sperber
DOI : 10.3844/ajidsp.2015.88.92
American Journal of Infectious Diseases
Volume 11, Issue 4
Emphysematous Pyelonephritis (EPN) is a rare, gas-forming infection of the renal parenchyma associated with significant morbidity and mortality. We report the case of a 39 year-old woman with uncontrolled diabetes who presented with abdominal pain, fevers and chills for one month. Physical exam was notable for dry oral mucosa and left costovertebral angle tenderness. Labs showed acute kidney injury and a hyperglycemic hyperosmotic state. CT abdomen revealed emphysematous pyelonephritis with a large left renal abscess. EPN should be considered in diabetic patients, especially those with uncontrolled or new-onset diabetes and those presenting with symptoms of urinary tract obstruction. Prognostic factors include thrombocytopenia, shock, altered mental status and need for hemodialysis. Our patient was treated successfully with intravenous antibiotics, percutaneous drainage, strict glucose control and monitored with serial imaging. She underwent laparoscopic nephrectomy one month later. Early diagnosis of EPN is essential as it carries a high mortality and a strong clinical suspicion is required, as patients may have an atypical presentation.
© 2015 Tasnim F. Imran, Frederick Yick, Ahmed H. Qavi, Sundar Dhamotharan and Steven J. Sperber. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.