Emphysematous Pyelonephritis Caused by Klebsiella pneumoniae Complicated With Multiple Metastatic Abscesses and...

Emphysematous pyelonephritis (EPN) is a life-threatening urinary tract infection that often requires prompt source control, including drainage, in addition to intensive supportive care. We report a severe case in which immediate invasive source control measures were not feasible; however, the patient survived with intensive multidisciplinary management. A 50-year-old man with poorly controlled diabetes mellitus presented with back pain and was diagnosed with left-sided EPN based on computed tomography. Owing to his overall critical condition, invasive renal or prostatic drainage was not performed. Blood and urine cultures revealed Klebsiella pneumoniae. During the clinical course, he developed multiple lung abscesses. On day 11, the patient experienced transient respiratory arrest, requiring mechanical ventilation and chest drainage. The patient gradually improved without nephrectomy or urinary diversion and was discharged on day 65 with functional recovery. Even when early invasive source control measures are not feasible in severe EPN, appropriate intensive multidisciplinary management may lead to favorable outcomes.