Emphysematous pyelonephritis complicated with extrarenal abscesses.

Area of Science:

• Nephrology
• Infectious Diseases
• Radiology

Background:

• Emphysematous pyelonephritis (EPN) is a rare, severe necrotizing infection of the kidney.
• Prompt diagnosis and aggressive management are critical due to its high mortality rate.

Purpose of the Study:

• To report a case of EPN with extensive subcutaneous gas and abscess formation in the thighs.
• To highlight the diagnostic challenges and treatment strategies for this life-threatening condition.

Main Methods:

• Case presentation of a 53-year-old male with diabetes mellitus.
• Diagnostic workup included plain X-ray, ultrasound, and CT scan of the abdomen.
• Treatment involved broad-spectrum antibiotics and repeated surgical drainage of renal and extra-renal abscesses.

Main Results:

• The patient presented with sepsis, pancytopenia, and renal failure.
• Radiological imaging confirmed gas in the renal parenchyma, collecting system, and subcutaneous thigh tissues with abscesses.
• Despite initial antibiotic treatment, the infection progressed, necessitating surgical intervention.

Conclusions:

• EPN is a rare but life-threatening condition, particularly when associated with extra-renal gas and abscesses.
• Successful management requires a multimodal approach including antibiotics and surgical drainage.
• Early recognition and intervention are key to improving outcomes in patients with EPN.