Foley Follies: Emphysematous Pyelitis from Instrumentation in Obstructive Uropathy.

Shimshon Wiesel,Militza Kiroycheva,Anna Gutman,Jonah E Abraham

doi:10.7759/cureus.1612

Shimshon Wiesel, Militza Kiroycheva + Show 2 more

Open Access

https://doi.org/10.7759/cureus.1612

Copy DOI

Abstract

Emphysematous pyelitis (EP) is a subclass of a life-threatening necrotizing infection of the urinary system called emphysematous pyelonephritis (EPN). We report a case of an 81-year-old man with emphysematous pyelitis, which occurred after urinary tract instrumentation and resolved with conservative medical management. This case highlights the potential complications of urinary tract manipulation and the importance of a prompt diagnosis.

Highlights

Emphysematous pyelitis (EP) is a subclass of a necrotizing infection of the urinary system called emphysematous pyelonephritis (EPN)
We report a case of an 81year-old nondiabetic man who developed EP after urinary tract manipulation
The patient's serum creatinine was 3.12 milligrams per deciliter, which was elevated from his outpatient baseline of 1.69 mg/dL, and urea nitrogen was 32 mg/dL

Summary

Introduction

Emphysematous pyelitis (EP) is a subclass of a necrotizing infection of the urinary system called emphysematous pyelonephritis (EPN). An 81-year-old man presented to our hospital for infected lower extremity ulcers and worsening kidney function His past medical history was significant for benign prostatic hyperplasia, chronic kidney disease stage IIIb, hypertension, and peripheral artery disease. The patient's serum creatinine (sCr) was 3.12 milligrams per deciliter (mg/dL), which was elevated from his outpatient baseline of 1.69 mg/dL, and urea nitrogen was 32 mg/dL His urinalysis showed small blood, large leukocytes, and 30 mg/dL of protein on urine dipstick, 20 to 30 white blood cells per high power field (p/hpf), three to six red blood cells p/hpf, few hyaline casts p/hpf, and occasional mucous threads on microscopic examination. Throughout his hospitalization, the patient denied abdominal pain, flank pain, suprapubic pain, dysuria, or urinary urgency, and he remained afebrile, with stable vital signs His renal function improved to its pre-admission baseline, so a percutaneous catheter drainage (PCD) of the renal pelvises was not performed. Follow-up details were obtained from the patient’s primary care physician, who informed us that a subsequent CT of the patient’s abdomen and pelvis demonstrated complete resolution of his EP

Discussion

Findings

Conclusions

Disclosures