The Importance of Early Imaging in Acute Pyelonephritis: A Case Report of Emphysematous Pyelonephritis

Emphysematous pyelonephritis (EPN) is a rare life-threatening infection that is usually encountered in diabetic patients. Herein, we are reporting a 41-year-old male patient with a past medical history of stage 3B chronic kidney disease (CKD), neurogenic bladder, and poorly controlled diabetes who presented with left-sided pyelonephritis and septic shock. E. coli was detected in urine and blood. Lack of adequate clinical response to appropriate antibiotic coverage prompted computed tomography (CT) scan of the abdomen that revealed EPN. Despite aggressive conservative management along with nephrostomy, the patient had multiple risk factors to fail conservative management and require nephrectomy. This left the patient on life-long dependence on hemodialysis. This case report is not only interesting as EPN is a rare clinical pathology, but it also helps to remind clinicians to remain vigilant on when to consider early imaging in pyelonephritis. In the appropriate clinical scenario of acute pyelonephritis in a diabetic patient with urinary obstruction, it is important to rule out EPN as an early diagnosis and conservative management including relief of urinary obstruction can lead to a better outcome, help preserve renal function, and spare nephrectomy.