Managing Patient With Coexisting Emphysematous Pyelonephritis And Cystitis

Area of Science:

• Nephrology
• Urology
• Infectious Diseases

Background:

• Emphysematous pyelonephritis (EPN) is a severe necrotizing renal infection.
• Emphysematous cystitis (EC) is a gas-producing bladder infection.
• Concomitant EPN and EC represent a rare and potentially life-threatening urological emergency.

Observation:

• A 45-year-old female presented with concurrent EPN and EC.
• Initial management included emergency percutaneous nephrostomy and Double J stenting.
• Despite initial clinical improvement, the patient developed recurrent UTIs, persistent fever, and a right kidney abscess.

Findings:

• The patient ultimately required a right-sided nephrectomy due to the non-resolving abscess and refractory infection.
• This combined presentation of EPN and EC is infrequently reported in medical literature.
• Successful management necessitates prompt and aggressive intervention, often involving surgical procedures.

Implications:

• This case underscores the importance of recognizing and managing rare urological emergencies.
• Aggressive treatment strategies, potentially including nephrectomy, may be required for severe, coexisting renal and bladder gas-forming infections.
• Further research into optimal management protocols for combined EPN and EC is warranted.