Gas-forming urinary tract infection

Area of Science:

• Urology
• Infectious Diseases
• Nephrology

Background:

• Emphysematous urinary tract infections (EUTIs) represent a rare but severe complication of bacterial infections.
• These infections carry significant life-threatening potential, necessitating prompt diagnosis and management.
• Diabetes mellitus is a known risk factor for developing complicated urinary tract infections, including emphysematous forms.

Observation:

• A 60-year-old Saudi female with a 15-year history of diabetes mellitus presented with acute left flank pain, abdominal distension, nausea, vomiting, and chills.
• She also reported urinary symptoms including increased frequency, urgency, and dysuria.
• Clinical examination revealed leukocytosis, hyperglycemia, elevated urea and creatinine, and pyuria.

Findings:

• Urine culture identified Escherichia coli as the causative pathogen.
• Imaging studies (ultrasound and CT scan) demonstrated left pelvicalyceal dilatation with gas formation within the left kidney and urinary bladder.
• These findings confirmed the diagnosis of emphysematous pyelonephritis.

Implications:

• The case highlights the importance of considering EUTIs in diabetic patients presenting with severe urinary symptoms and signs of infection.
• Prompt diagnosis through clinical evaluation and appropriate imaging is crucial for effective management.
• Successful treatment involved a prolonged course of parenteral antibiotics and insulin therapy, leading to complete recovery and emphasizing the critical role of glycemic control.