A case report on the atypical presentation of Renal tuberculosis as emphysematous pyelonephritis

Emphysematous pyelonephritis (EPN) is a severe acute necrotizing infection, that causes gas to build up in the collecting system, renal parenchyma, and perirenal tissues (Mahmood et al., 2020). Uncontrolled diabetes mellitus and urinary tract obstruction are the two main risk factors. We report the second case report of tuberculosis as a causative pathogen of EPN.

In this case report, a 60-year-old lady with poorly controlled type 2 diabetes was admitted to the emergency room due to left flank pain, a low-grade temperature, nausea, and vomiting. Emphysematous Pyelonephritis was diagnosed based on gas seen in the renal parenchyma on a CECT scan (EPN). She underwent conservative management, including the insertion of a nephrostomy tube and antibiotics. There is no growth detected in the nephrostomy drain's culture. She underwent a simple nephrectomy after deciding that she had not improved clinically after receiving conservative treatment. A biopsy of the specimen revealed a tuberculosis abscess. She received the proper care and made clinical progress over the course of a six-month anti-TB medication regimen.

The majority of EPN patients are female (2:1) and diabetic (90 %) with a mean age of presentation of 55 years (El Rahman et al., 2011). The preferred method of diagnosis for EPN is CT (El Rahman et al., 2011). E. coli, Klebsiella, and Pseudomonas were the most prevalent species in many of the reported cases (Khaira et al., 2009). In contrast to prior investigations, we discovered a case of EPN caused by tuberculosis invasion.

An essential lesson to learn from such cases is the importance of considering genitourinary tuberculosis when emphysematous pyelonephritis does not improve with conservative treatment, especially in areas with a high tuberculosis endemicity.