Emphysematous Urinary Tract Infections Research Articles

Diabetic myonecrosis complicated by emphysematous pyomyositis and abscess caused by Escherichia coli: a case report

BackgroundNecrotizing myopathies and muscle necrosis can be caused by immune-mediated mechanisms, drugs, ischemia, and infections, and differential diagnosis may be challenging.Case presentationWe describe a case of diabetic myonecrosis complicated by pyomyositis and abscess caused by Escherichia coli. A white woman in her late forties was admitted to the hospital with a 1.5 week history of bilateral swelling, weakness, and mild pain of the lower extremities and inability to walk. She had a history of type 1 diabetes complicated by diabetic retinopathy, neuropathy, nephropathy, and end-stage renal disease. C-reactive protein was 203 mg/l, while creatinine kinase was only mildly elevated to 700 IU/l. Magnetic resonance imaging of her lower limb muscles showed extensive edema, and muscle biopsy was suggestive of necrotizing myopathy with mild inflammation. No myositis-associated or myositis-specific antibodies were detected. Initially, she was suspected to have seronegative immune-mediated necrotizing myopathy, but later her condition was considered to be explained better by diabetic myonecrosis with multifocal involvement. Her symptoms alleviated without any immunosuppressive treatment. After a month, she developed new-onset and more severe symptoms in her right posterior thigh. She was diagnosed with emphysematous urinary tract infection and emphysematous myositis and abscess of the right hamstring muscle. Bacterial cultures of drained pus from abscess and urine were positive for Escherichia coli. In addition to abscess drainage, she received two 3–4-week courses of intravenous antibiotics. In the discussion, we compare the symptoms and findings typically found in pyomyositis, immune-mediated necrotizing myopathy, and diabetic myonecrosis (spontaneous ischemic necrosis of skeletal muscle among people with diabetes). All of these diseases may cause muscle weakness and pain, muscle edema in imaging, and muscle necrosis. However, many differences exist in their clinical presentation, imaging, histology, and extramuscular symptoms, which can be useful in determining diagnosis. As pyomyositis often occurs in muscles with pre-existing pathologies, the ischemic muscle has likely served as a favorable breeding ground for the E. coli in our case.ConclusionsIdentifying the etiology of necrotizing myopathy is a diagnostic challenge and often requires a multidisciplinary assessment of internists, pathologists, and radiologists. Moreover, the presence of two rare conditions concomitantly is possible in cases with atypical features.

A case of abdominal distress and kidney dysfunction in a patient with diabetes.

A 65-year-old male with diabetes mellitus and dyslipidemia presented with a fever and dysuria for the past week. He developed hematuria, lower abdominal discomfort, and constipation. During examination, tachycardia (120 beats per min) and relative hypotension (96/57 mmHg) were observed. Laboratory tests revealed acute kidney injury with metabolic acidosis (serum creatinine of 5.47 mg/dL, pH value 7.29 BE: −7.7). Kidney, ureter, and bladder imaging showed bladder distension with gas formation (Figure 1). An abdominal computed tomography scan revealed emphysematous cystitis (Figure 2). The patient was initially treated with foley irrigation and antibiotics, but he developed respiratory distress on the same day and was intubated for urosepsis. Blood and urine cultures showed Klebsiella pneumoniae. He received temporary hemodialysis due to refractory fluid overload and Kidney Disease Improving Global Outcomes (KDIGO) stage III acute kidney injury by serum creatinine criteria during hospitalization. Emphysematous urinary tract infections (UTIs) involve gas formation in the urinary tract and are commonly caused by Escherichia coli or Klebsiella pneumoniae, particularly in individuals with diabetes.1 Emphysematous cystitis is a rare type of UTI characterized by gas formation in the bladder wall. The symptoms include abdominal pain, dysuria, and pneumaturia. The diagnosis is made through imaging, and treatment involves antibiotics.2 In severe cases, hospitalization may be required. Emphysematous cystitis is a rare but serious complication of UTIs, particularly in individuals with diabetes. Early diagnosis and appropriate management, including antibiotics and surgical therapy, if necessary, are essential for improving outcomes.3 Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of our research.

Emphysematous Pyelonephritis and Diabetes Mellitus

Emphysematous urinary tract infections (UTIs) are lower or upper UTIs associated with gas formation. Emphysematous pyelonephritis (EPN) is a rare disease but is highly prevalent in patients with diabetes and even higher among female patients with diabetes. Earlier, the mortality rate of EPN was 60%–80%, but now, it has been reduced to 20% to 25% due to the availability of good antimicrobial agents and timely treatment. Our objective of this article is to elucidate the pathogenesis of EPN including gas-forming mechanism; discuss clinical features, radiological classification, and prognostic factors; in addition, compare the modalities of management of EPN and outcome among the various radiological classes.

Emphysematous Pyelonephritis, Emphysematous Cystitis, and Emphysematous Ureteritis: A Case Report

Emphysematous urinary tract infections (EUTIs) are rare, severe, and suppurative infections affecting various parts of the urinary tract. We report a case of a 75-year-old male presenting with hematuria and generalized weakness withuncontrolled diabetes mellitus (DM) and hypertension. He tested positive for COVID-19on the second day of hospital admission. A non-contrast-enhanced CT of the abdomen and pelvis revealed gas within the left renal parenchyma, walls of the left ureter, and urinary bladder, establishing the diagnosis of EUTIs. The patient was treated using intravenous antibiotics without any surgical intervention, and four weeks later was stable and transported tolong-term acute care (LTAC) facility. DM is the most common risk factor for the development of EUTIs and Escherichia coli is the most common causative pathogen.

Nephron Sparing Management of Complex Emphysematous Urinary Tract Infection of the Whole Urinary System: A Case Report

Emphysematous urinary tract infections (EUI) are rare life-threatening infections that are often found in diabetic patients with a predilection for females. Emphysematous pyelonephritis (EPN) is more frequently reported than emphysematous cystitis (EC). However, concurrent occurrence has been reported as well. On the other hand, ureteric involvement in cases of EUI has not been described well in the literature. Treatment should be aggressive as the rate of death can be as high as 15.4%. Early surgical intervention has been described for severe infections. However, conservative approach has also been adopted especially in cases where preserving kidney function is of utmost importance. We present a 22-year-old lady who is known to have chronic kidney disease, bladder dysfunction and multiple reconstructive urological procedures, presented with emphysematous urinary tract infection affecting the whole urinary system (both kidneys, ureters and urinary bladder), which was successfully treated in a nephron sparing approach.

Diabetic Ketoacidosis Triggered by an Emphysematous Urinary Tract Infection: A Case Report and Mini-Review of Literature

Generally, the most common triggers for Diabetic Ketoacidosis (DKA) are infectious diseases, such as Urinary Tract Infections (UTIs) or pneumonia. However, emphysematous infections are significant diseases rarely associated with DKA. Here, we present two cases of emphysematous urinary tract infection associated to diabetic ketoacidosis, highlighting the importance of a timely intervention and treatment. We review the need for appropriate laboratory and image testing in the context of infected patients who do not reach inflammatory/ glycemic goals to diagnosticate complicated infectious processes. This case report and mini-review also explore pathophysiology, the association of DKA and urinary emphysematous infections and treatment options.

CT and MRI in Urinary Tract Infections: A Spectrum of Different Imaging Findings.

There are many acute and chronic infections affecting the urinary tract including bacterial, fungal and viral infections. Urinary tract infections (UTIs) can present in many different patterns with variable degrees of severity varying from asymptomatic and uncomplicated forms to life threatening complicated infections. Cross-sectional imaging techniques—including both computed tomography (CT) and magnetic resonance imaging (MRI)—have become very important tools not only for evaluation of UTIs, but also for detection of associated complications. Selection of either CT or MRI in the UTI evaluation depends on several factors such as the presence of contraindication, experience, cost and availability. CT and MRI help in early detection and management of UTIs that reduce the prevalence and severity of complications. In this article we will present the radiologic findings at CT and MRI in different types of upper and lower UTIs including acute pyelonephritis, intrarenal and perinephric abscesses, pyonephrosis, chronic pyelonephritis, emphysematous UTIs, xanthogranulomatous pyelonephritis, tuberculosis (TB), bilharziasis, fungal infection, corynebacterium infection, ureteritis, cystitis, prostatitis, prostatic abscess and urethritis.

Acute Renal Infection in Adult, Part 2: Emphysematous Urinary Tract Infection—What the Radiologist Needs to Know

AbstractRenal emphysema, as described by Kelly and MacCallum in 1898, refers to the spontaneous generation of gas within the renal parenchyma and surrounding tissues. Since its initial description, it has become apparent that the spectrum of radiologically visible renal and perirenal gas includes three distinct clinical entities: (1) emphysematous pyelonephritis, a necrotizing infection associated with gas formation in the renal parenchyma, (2) emphysematous pyelitis, in which gas is confined to the renal pelvis and calyces, and (3) gas-forming perinephric abscess. In this article, we will review gas-forming infections of the urinary system in terms of radiological features, clinical manifestations, predisposing factors, and appropriate management guidelines.

A Rare Case of Asymptomatic Emphysematous Pyelonephritis

Emphysematous urinary tract infection is a rare spectrum of disease which can potentially run a fulminant course ending in severe morbidity or even mortality.

Bilateral psoas muscle abscess associated with emphysematous cystitis.

Psoas muscle abscess associated with emphysematous urinary tract infection is very rare. There were very few reports about urinary tract infections such as renal abscess, perinephric abscess, and emphysematous pyelonephritis complicated with psoas muscle abscess; however, psoas muscle abscess associated with emphysematous cystitis has not yet been reported. Here, we report a case of bilateral posas muscle abscess following emphysematous cystitis in an 81-year-old nondiabetic man, who was treated successfully with prolonged antibiotic therapy and supportive care. Early recognition of psoas muscle abscess can prevent aggressive interventional procedure and warrant good prognosis.

Ultrasound Contribution to the Diagnosis of Emphysematous Cystitis

Emphysematous cystitis is a severe urinary tract infection which threatens patients’ life. Thus, it requires early diagnosis and computed tomography (CT) is the reference medical exam used to address it. However, ultrasound, which is a non-ionizing and very accessible technique, may also contribute to diagnosis. The aim of this study was to illustrate the contribution of ultrasound to the diagnosis of emphysematous cystitis. We report three cases of emphysematous cystitis diagnosed by ultrasound. In all the cases, ultrasound identified basic signs showing presence of gas, including a hyperechoic cystic parietal thickening, repeat echoes and dirty shadow cones of intraluminal focus. Diagnostic confirmation was made in two cases through X-ray and in one case by means of computed tomography. Through simple basic signs, ultrasound directs most usefully towards an emphysematous urinary tract infection. CT enables a more accurate diagnostic work-up of lesions and differential diagnosis with vesico-digestive fistula.

Concomitant Emphysematous Pyelonephritis and Ureteritis

Case: A 58 year-old woman presented with fever, and right flank pain for two days. In addition, gross hematuria was noted this morning. The patient had a history of diabetes mellitus. On arrival, her vital signs were temperature of 39°C, pulse rate of 127/min, respiratory rate of 24/min, and blood pressure of 96/65 mm Hg. Physical examinations only disclosed mild right flank knocking tenderness. Laboratory examinations were as follows: white cell count 22,300/mm3 with predominance of neutrophils (97%), platelet 30,000/mm3 , C-reactive protein of 269 mg/L (reference value, less than 3 mg/L). Urinary analysis showed both of white blood cells and red blood cells greater than 100/high power field. Radiography of the abdomen revealed air within right ureter and in the right kidney area (Figure 1). Computed tomography of the abdomen disclosed emphysematous pyelonephritis with concomitant emphysematous ureteritis and a ureteral stone (Figure 2). Therefore, the patient received antibiotic with flomoxef for severe urosepsis and emergent placement of a percutaneous nephrostomy. Three days later, all of her blood cultures, and pus collected from the drain grew Escherichia coli. Thereafter, the clinical condition became stable and she was discharged two weeks later. Emphysematous urinary tract infection is a necrotizing infection, which is characterized by the accumulations of air in the renal parenchyma, collecting system or urinary bladder. E. coli and Klebisella pneumoniae are the most common pathogens, and diabetes mellitus is major risk factor. The mortality may be up to 18-40%, and prompt management including systemic antibiotics and immediate drainage or surgical intervention, are essential for life-saving [1]. Image study such as a simple KUB or CT can be helpful for diagnosis.

下大静脈内にair bubbleを認めた気腫性膀胱炎の1例

A 76-year-old diabetic woman was referred to our hospital with an episode of high fever and sub-abdominal pain. Computed tomography (CT) of the pelvis revealed gas accumulation within the lumen and wall of the bladder and CT of the abdomen demonstrated bubbles in the inferior vena cava. She recovered by urinary drainage and antibiotic therapy. Urinary culture revealed Escherichia coli. CT after the therapy didn't demonstrate gas accumulation of the bladder and bubbles in the inferior vena cava. Emphysematous urinary tract infections (UTIs) have the high fatality rate, it seems to be a possibility that venous bubbles with emphysematous UTIs contribute to the high fatality rate such as air embolisms. It was suspected that bacterial injury of the bladder wall and high vesical pressure caused by urinary outlet obstruction such as neurogenic bladder lead gas translocation into the venous system. Six previous cases of emphysematous UTIs (three emphysematous cystitis cases and three emphysematous pyelonephritis cases) with venous bubbles have been reported to this day. Our case is seems to be the fourth case report that venous bubbles with emphysematous cystitis was demonstrated.

Emphysematous pyelonephritis: an uncommon fatal complication of type 1 diabetes

Emphysematous urinary tract infections are associated with gas formation within the upper or lower urinary tracts. Diabetes is a major risk factor for these infections which can present as cystitis, pyelitis or pyelonephritis associated with peri nephric abscesses. Emphysematous pyelonephritis (EPN) is a serious, uncommon, necrotising infection affecting the renal parenchyma. The first case of a gas forming renal infection was reported by Kelly and

Clinical Outcomes of Nonoperative Management in Emphysematous Urinary Tract Infections

To investigate the clinical outcomes of nonoperative management of emphysematous urinary tract infections (EUTIs). We retrospectively reviewed 28 consecutive cases of EUTI over a 5-year period, all of which were treated with urinary drainage and medical management without surgical intervention. EUTIs were classified as either emphysematous pyelonephritis (EP) or emphysematous cystitis (EC). Clinical, diagnostic, and therapeutic data were analyzed. Of the 28 patients evaluated, 13 had EP and 15 had EC, all of which were diagnosed by computed tomography. Of EP patients, the mean age was 54 years with a median serum creatinine (sCr) of 1.8 mg/dL (estimated glomerular filtration rate [eGFR] 38 mL/min/1.73 m(2)). Obstructive uropathy was present in 69%, and 100% received antibiotics and percutaneous drainage without mortality. Median follow-up was 10 months without any subsequent nephrectomy and median sCr decreased to 1.1 mg/dL (P = .04) and eGFR increased to 63.5 mL/min/1.73 m(2) (P = .06). Of EC patients, the mean age was 60 years with a median sCr of 1.3 mg/dL (eGFR 55 mL/min/1.73 m(2)). All were managed with antibiotics and catheter drainage with a single mortality (7%). Median follow-up was 2 months and median sCr decreased to 1.2 mg/dL (P = .83) and eGFR increased to 46 mL/min/1.73 m(2) (P = .68). The most common causative pathogen was Escherichia coli for both EP (54%) and EC (53%). Early detection, medical management, and urinary drainage of EUTI can result in a favorable prognosis. This strategy results in low levels of mortality without the need for surgical intervention and can preserve renal function.

Emphysematous Urinary Tract Infections: Diagnosis, Treatment and Survival (Case Review Series)

Emphysematous urinary tract infections are rare conditions, usually occurring in diabetic patients. Mortality rates in medically managed patients are reported to be as high as 70% to 90%. Growth of the diabetic population warrants heightened attention to these potentially fatal infections. We report a series of 5 cases with favorable outcomes. All patients were diabetic. Presenting symptoms included fever, chills, nausea, vomiting, and abdominal pain. On physical examination, two patients had costovertebral angle tenderness; a third was dehydrated; a fourth had dehydration and an abdominal mass; and a fifth patient had suprapubic tenderness. All cases had leukocytosis and impaired renal function. Computed tomography (CT) scan disclosed emphysematous pyelonephritis in 3 cases (gas within renal parenchyma and/or perirenal tissue), emphysematous pyelitis in 1 case (gas in collecting system), and emphysematous cystitis in 1 patient (gas within bladder wall). Urine culture of 1 case grew Enterococci, whereas in the other cases cultures yielded gas-producing organisms. All patients received intravenous antibiotics. Two patients underwent CT-guided abscess drainage; 2 cases had J-stent placement, and one patient was readmitted with septic shock and underwent nephrectomy. All the patients' conditions improved and they were discharged. Emphysematous urinary tract infections are usually caused by gas-producing organisms. They should be suspected in diabetic patients with urinary tract infections and worsening of renal function. CT scan is the method of choice for diagnosis and follow up. None of our patients died, mainly due to early diagnosis, sequential radiologic assessment, and timely surgical intervention when needed.