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Published on: July 18, 2017

Fulminant emphysematous pyelonephritis (EPN) in a diabetic patient suspected of having multiple tumors

Junko Sato1, Hajime M Koyano, Ruri Sasaki

  • 1Division of Metabolism and Endocrinology, Department of Internal Medicine, Juntendo Urayasu Hospital, Urayasu. jsato@juntendo.ac.jp

Internal Medicine (Tokyo, Japan)
|November 5, 2010
PubMed

Insights

A diabetic patient with multiple tumors developed a severe urinary infection and sepsis, leading to a fatal hyperglycemic hyperosmolar non-ketotic coma. Postmortem imaging revealed emphysematous pyelonephritis (EPN), a rare infection.

Area of Science:

  • Medicine
  • Pathology
  • Radiology

Background:

  • Diabetes mellitus is a significant risk factor for various infections.
  • Early detection and management of infections are crucial in diabetic patients.
  • Emphysematous pyelonephritis (EPN) is a rare but severe bacterial infection of the kidney.

Observation:

  • A diabetic woman presented with incidentally discovered tumors in the liver, kidney, and urinary bladder.
  • She initially refused surgery and was monitored for two months.
  • The patient was later found unconscious and diagnosed with urinary infection, sepsis, and hyperglycemic hyperosmolar non-ketotic coma.

Findings:

  • The patient experienced a rapid, fatal clinical course.
  • Postmortem computed tomography (CT) confirmed the presence of emphysematous pyelonephritis (EPN).
  • The case illustrates a rare, life-threatening infection in a patient with uncontrolled diabetes and potential underlying malignancy.

Implications:

  • This case underscores the critical need for vigilant infection management in diabetic individuals.
  • It may offer insights into the pathogenesis of EPN, particularly in the context of diabetes.
  • Prompt diagnosis and treatment of infections in diabetic patients can prevent severe complications and mortality.

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