Emphysematous pyelonephritis: a rare presentation

Area of Science:

• Nephrology
• Endocrinology
• Infectious Diseases

Background:

• Emphysematous pyelonephritis is a rare, life-threatening renal infection associated with diabetes.
• It typically presents with symptoms like fever, nausea, vomiting, and abdominal pain, potentially leading to shock or confusion.
• Diabetic ketoacidosis is an uncommon but serious presentation of this condition.

Observation:

• An elderly female presented with symptoms of abdominal pain, fever, vomiting, and confusion.
• The patient was diagnosed with diabetic ketoacidosis and metabolic encephalopathy concurrently with right-sided emphysematous pyelonephritis.

Findings:

• The patient demonstrated an excellent clinical response to conservative medical management.
• No surgical intervention was required for the emphysematous pyelonephritis.

Implications:

• Diabetic ketoacidosis can be an uncommon but presenting feature of emphysematous pyelonephritis.
• Conservative medical treatment can be effective in managing emphysematous pyelonephritis in select diabetic patients.
• This case underscores the importance of considering severe infections in diabetic patients presenting with ketoacidosis.