Abstract
Fulminant Emphysematous Pyelonephritis: Case Report and Revision of the Literature
Highlights
Emphysematous pyelonephritis (EPN) is an acute necrotizing parenchymal secondary to gas-forming uropathogens and mortality rates in medically managed patients are as high as 70–90% [1]; it should be suspected in diabetic and in immunosuppressed patients with urinary tract infections and worsening of clinical conditions
We report a 56-year-old woman who presented with urinary sepsis that needed emergency nephrectomy in view of her worsening condition
An ultrasound of the abdomen showed hydronephrosis of the right kidney; a computed tomography (CT) scan of the abdomen performed without contrast medium showed hydronephrosis of the right kidney (Figure 1a) secondary to a stone placed in the homolateral iuxtavesical ureter
Summary
Emphysematous pyelonephritis (EPN) is an acute necrotizing parenchymal secondary to gas-forming uropathogens and mortality rates in medically managed patients are as high as 70–90% [1]; it should be suspected in diabetic and in immunosuppressed patients with urinary tract infections and worsening of clinical conditions. A 56-year-old woman, a known type 2 diabetes mellitus in treatment with oral hypoglycemics, multiple sclerosis in therapy with immunosuppressive drugs presented to our emergency department with right flank pain for 8 days, associated with fever (38.6°) and dysuria. At admission, she was disoriented; blood exams showed sugar levels of 238 mg%, urea 85 mg%, serum creatinine 1.3 mg%, total leukocyte count 15,200/mm, and a platelet count of 116,000/mm, C-reactive protein (PCR 9.3) and procalcitonine 0.4. Definitive specimen showed the presence of an acute and extensive pyelonephritis
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