A case of fatal emphysematous pyelonephritis presenting as lower limb gaseous gangrene

The aim of this paper was to focus on emphysematous pyelonephritis (EPN), which is a severe disease that is rarely described in intensive care literature, although it is well-considered in urology and radiology journals, with numerous case reports. A 61 year-old diabetic and obese woman admitted to the Intensive Care Unit (ICU) was diagnosed with gas gangrene of the left lower limb. Within a few hours, the patient needed mechanical ventilation and high inotropic support. The abdominal computed tomography (CT) scans showed bilateral renal calculi and gas within the renal parenchyma extending towards the lower limb. Despite aggressive antibiotic therapy, supportive intensive treatment and nephrectomy, the patient died after 5 days. EPN is a rare but severe disease whose early recognition is fundamental for a favorable outcome. Intensivists should reasonably suspect it whenever diabetic patients develop septic conditions and signs of gas collection in the abdomen, pelvis, retroperitoneal space or even in the lower limbs.