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Case report: Bilateral emphysematous pyelonephritis with pneumatosis intestinalis
Maria D'Amico1, Joseph Izes1, Akhil Das1
1Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
Urology Case Reports
|October 29, 2021
Summary
Emphysematous pyelonephritis, a rare infection causing gas in the kidneys, can worsen despite initial treatment. This case highlights a severe progression to bilateral involvement and intestinal gas in a patient with new-onset diabetes and cirrhosis.
Area of Science:
- Nephrology
- Infectious Diseases
- Gastroenterology
Background:
- Emphysematous pyelonephritis is a rare, severe necrotizing renal infection characterized by gas formation.
- Diabetes mellitus is a significant risk factor, often associated with poor outcomes.
- Standard treatments include antibiotics and drainage, with nephrectomy reserved for severe cases.
Observation:
- A 40-year-old female with newly diagnosed diabetes and cirrhosis presented with left-sided emphysematous pyelonephritis.
- Initial management involved intravenous antibiotics and percutaneous drainage of the renal collecting system.
- The patient's condition deteriorated, necessitating further investigation.
Findings:
- Repeat imaging demonstrated progression to bilateral emphysematous pyelonephritis.
- Pneumatosis intestinalis (gas in the intestinal wall) was also identified on subsequent imaging.
- This indicates a severe, systemic spread of the gas-producing infection.
Implications:
- This case underscores the aggressive nature of emphysematous pyelonephritis in patients with uncontrolled diabetes and liver disease.
- It highlights the potential for rapid deterioration and bilateral involvement, even after initial interventions.
- Close monitoring and consideration of advanced imaging are crucial for timely diagnosis and management of complications like pneumatosis intestinalis.
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