Emphysematous pyelonephritis caused by clostridium septicum and complicated by a mycotic aneurysm

Abstract

Emphysematous pyelonephritis (EP) is a rare and lifethreatening necrotizing infection in the renal parenchyma caused by gas-producing microorganisms (Michaeli et al, 1984). Mycotic aneurysms are vascular lesions caused by infectious weakening of the arterial wall (Skipper et al, 1991). Clostridium septicum (CS) is an anaerobic bacterium, known for its propensity to produce gas (Michaeli et al, 1984) and its association with malignancy especially carcinoma of the colon (Alpern & Dowell, 1969). We present the first recorded case of EP complicated by a mycotic aneurysm of the abdominal aorta. Furthermore, this is the first case of EP resulting from infection with a pure culture of true gas-forming bacteria (CS) and the fifth case of a mycotic abdominal aortic aneurysm due to CS. A 74-year-old dehydrated diabetic woman with an abdominal pulsatile mass, a necrotic ulcer over the sacrum and temperature of 38.0°C was admitted to hospital with a 3-week history of generalized malaise, confusion, lethargy, bloody and mucoid diarrhoea, anaemia, fever and cystitis. Fluid replacement, electrolyte and glucose correction and antimicrobial therapy were initiated.