Emphysematous Pyelonephritis Complicated by Sub Capsular Renal Hematoma: A Case Report

Abstract

Emphysematous pyelonephritis is a rare and serious life-threatening condition due to a fulminant infection of the urinary tract. It is most often seen in diabetics and is defined by the presence of gas in the renal parenchyma secondary to bacterial infection. We highlight an unusual presentation (extensive renal sub capsular hematoma) of this condition and detail diagnostic and management considerations, including choice of imaging modalities. We present the case of a 63-year-old woman admitted to the emergency room for the management of severe sepsis secondary to an emphysematous pyelonephritis complicated by a large subcapsular hematoma of the kidney having extended into the omental bursa. To our knowledge, this complication is unique and never has been reported in the literature. Surgical treatment was necessary to control this severe infection. The medical and surgical management of emphysematous pyelonephritis must be aggressive and well-coordinated, early diagnosis, antibiotics and assessment for operative intervention are essential. Diabetes is the principal risk factor as well as immunodepression. The prognosis remains poor of this serious infection. Sub capsular hematoma is unusual and a good parameter to assess the severity of this infection. The presence pf gas in the urinary tract is the sign of the presence of an active anaerobe infection.