Case Report

Emphysematous pyelonephritis: A Life-threatening but treatable condition with high suspicion in Diabetic patients: A Case Report

Abstract

Background: Emphysematous pyelonephritis (EP) is a rare necrotizing infection of the kidney with high morbidity and mortality. Susceptivity to infection, impaired tissue perfusion and high tissue glucose levels in uncontrolled diabetic patient and obstruction of urinary tract are main etiological factors. And emphysematous UTIs are usually due to Escherichia coli or Klebsiella pneumoniae among 65% of the affected individuals. Case Report: We herein report a case of 51-year-old woman with uncontrolled diabetes mellitus who was admitted to casualty surgical ward with septic shock and acute abdominal pain with AKI. On admission ultra sound scan findings were suggestive of right sided pyelonephritis but repeated CECT abdomen after five days found right sided swollen kidney with large air collection around kidney. The diagnosis of emphysematous pyelonephritis was made and right sided JJ stent inserted. Despite of ten days of IV antibiotic and stenting clinical improvement was poor and repeated scan revealed in addition to EP, air conditioning collection extends into perinephric region with rising inflammatory markers. Urgent open surgical drainage of perinephric abscess done and drain inserted. The postoperative course was successful with reduction of inflammatory markers and patient clinically got better. Conclusion: Emphysematous pyelonephritis though is an rare condition but always better to suspect in an uncontrolled diabetic or  immunocompromised patient who poorly respond to pyelonephritis with IV antibiotic and attention must be paid to the selection of non medical management when not responding to adequate IV antibiotic such percutaneous drainage or open drainage of abscess.