Bilateral Extensive Emphysematous Pyelonephritis

Objective: We report a case involving a patient with bilateral emphysematous pyelonephritis (EPN) who was successfully treated with antibiotics and nephrostomy sparing nephrectomy. Case Presentation and Intervention: A 54year-old diabetic man presented with the chief complaint of progressive abdominal pain for 10 days. Blood tests indicated acute renal failure and hyperglycemic hyperosmolar state. An abdominal radiograph disclosed gas distributed over regions where the bilateral kidneys are located and the right para-lumbosacral area. Computed tomography revealed bilateral enlarged kidneys with the presence of gas in the renal parenchyma and renal pelvis, left peri-renal space, bilateral ureter, bladder, prostate gland and right scrotum. Cultures of urine and blood grew Escherichia coli . The patient was successfully treated with antibiotics coupled with nephrostomy. Conclusion: Timely recognition and initiation of effective antibiotic therapy and nephrostomy may cure the patient with bilateral EPN, while sparing nephrectomy. Regarding clinical manifestations, EPN is nonspecific; hence, radiographs should be taken for diabetic patients with abdominal pain (especially those with poorly controlled blood sugar) to enable early diagnosis of potential EPN. Copyright © 2009 S. Karger AG, Basel Received: September 20, 2007 Revised: January 22, 2008 Dr. Jien-Wei Liu Division of Infectious Diseases, Department of Internal Medicine Chang Gung Memorial Hospital – Kaohsiung Medical Center, 123 Ta Pei Road Niao Sung Hsiang, Kaohsiung Hsien 833 (Taiwan) Tel. +886 7 731 7123, ext. 8304, Fax +886 7 732 2402, E-Mail [email protected] © 2009 S. Karger AG, Basel 1011–7571/09/0182–0149$26.00/0 Accessible online at: www.karger.com/mpp D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /2 0/ 20 17 1 2: 44 :5 8 P M