Emphysematous Pyelonephritis with Abscesses Masquerading as an Ordinary Urinary Tract Infection

摘要

Emphysematous Pyelonephritis (EPN) is a rare,gas-forming infection of the renal parenchyma associated with significantmorbidity and mortality. We report the case of a 39 year-old woman withuncontrolled diabetes who presented with abdominal pain, fevers and chills forone month. Physical exam was notable for dry oral mucosa and leftcostovertebral angle tenderness. Labs showed acute kidney injury and ahyperglycemic hyperosmotic state. CT abdomen revealed emphysematouspyelonephritis with a large left renal abscess. EPN should be considered indiabetic patients, especially those with uncontrolled or new-onset diabetes andthose presenting with symptoms of urinary tract obstruction. Prognostic factorsinclude thrombocytopenia, shock, altered mental status and need forhemodialysis. Our patient was treated successfully with intravenousantibiotics, percutaneous drainage, strict glucose control and monitored withserial imaging. She underwent laparoscopic nephrectomy one month later. Early diagnosisof EPN is essential as it carries a high mortality and a strong clinicalsuspicion is required, as patients may have an atypical presentation.