Lemierre’s syndrome variant with inferior vena cava and right common iliac vein thrombosis secondary to emphysematous pyelonephritis

Abstract Background Emphysematous pyelonephritis (EPN) is a potentially life-threatening disease with Escherichia coli ( E. ) being the most common aetiology. Infection can involve renal parenchyma, collecting system and perinephric tissues, commonly encountered in patients uncontrolled diabetes mellitus. EPN complicated by suppurative thrombophlebitis of inferior vena cava rare occurrence. Our case had thrombosis right iliac vein as well, which first its kind reported EPN. Case presentation We describe 59-year-old male patient, mellitus, who presented to emergency department history high-grade fever left loin pain. Clinico-laboratory findings were diagnostic for upper urinary tract infection sepsis. A preliminary ultrasound abdomen was indicative hydronephrosis features emphysematous pyelonephritis. Abdominal computed tomography (CT) done ascertain cause hydronephrosis. Left ureteric calculus (type 3a) intraluminal air (IVC). Culture grew . Patient started on insulin intravenous (IV) antibiotics, bilateral DJ stenting done. symptomatically better discharged. month later, he readmitted relapse symptoms; repeat CT showed abscess, vein, thrombosis. Repeat culture , stent replaced, subsequently underwent ultrasound-guided aspiration abscess. Haemodialysis along IV antibiotics anticoagulant therapy started. Conclusion Suppurative association rare; however, same associated higher morbidity mortality. Prompt diagnosis, drainage procedure, coupled anticoagulants are mainstay treatment deep venous thrombophlebitis.