A case of emphysematous pyelonephritis presenting as leg pain- a multi disciplinary approach


  • Ashin Varghese Department of Internal Medicine, Aster Medcity, Kochi, India http://orcid.org/0000-0003-3885-5728
  • Anuroop Balagopal Department of Intensive Care Medicine, Aster Medcity, Kochi, India
  • Arun Wilson Department of Infectious Diseases, Aster Medcity, Kochi, India




Bacterialinfection, Disease control, Diagnosis, Treatment, Urologic


Emphysematous pyelonephritis is a rare and severe infection of the kidney, which is characterized by necrotising changes in the renal parenchyma and accumulation of gas in the peri-renal tissue. The causative organism is usually a gas forming gram negative bacteria. We present a case of 65 years old gentleman presenting with leg pain, little lower urinary tract symptoms of fever, referred to our hospital with a renal mass requiring nephrectomy. He was subsequently diagnosed as EPN, requiring aggressive antibiotic therapy, haemodialysis, fasciotomy and surgical debridement. This case highlights the timely interventions required by multiple specialities and aggressive management including surgical intervention essential for an acceptable recovery. We have also tried to understand the pathophysiology of the disease and why it responds poorly to treatment.

Author Biography

Ashin Varghese, Department of Internal Medicine, Aster Medcity, Kochi, India

PG registrar -Internal medicine


Jain SK, Agarwal N, Chaturvedi SK. Emphysematous pyelonephritis: a rare presentation. J Postgrad Med. 2000;46:31

Patro S, Khora PK, Padhy SK. Emphysematous pyelonephritis a rare case report. Int J Adv Med. 2017;4:596-9.

Hooton T. Urinary tract infections in adults. In: Jurgen F, Johnson RJ, Feehally J, eds. Comprehensive Clinical Nephrology. 4th ed. Philadelphia: Mosby Elsevier Inc; 2010:638.

Falagas ME, Alexiou VG, Giannopoulou KP, Siempos II. Risk factors for mortality in patients with emphysematous pyelonephritis: A meta-analysis. J Urol. 2007;178:880-5.

Turney JH. Renal conservation for gas-forming infections. Lancet. 2000;355(9206):770-1.

Hui L, Tokeshi J. Emphysematous pyelonephritis. Hawaii Med J. 2000;59(8):336-7.

Somani BK, Nabi G, Thorpe P, Hussey J, Cook J, N’Dow J, et al. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol. 2008;179(5):1844-9

Fatima R, Jha R, Muthukrishnan J, Gude D, Nath V, Shekhar S, et al. Emphysematous pyelonephritis: a single center study. Indian J Nephrol. 2013;23(2):119.

Oh YK, Choi YH, Sung CK, Lim CS. Emphysematous pyelonephritis treated with percutaneous catheter drainage and antibiotics. Nephrol Dialysis Transplant. 2006;21(11):3331-2.

Huang JJ, Tseng CC. Gas-forming mechanism of emphysematous pyelonephritis (EPN) by gas analysis and pathology in nephrectomy. Nephrol Dial Transplant. 1998;13:A54.

Mamoun N, Hossam EG, Pedro R, Shadab A. Successful medical management of emphysematous pyelonephritis. Am J Med. 2002;52:152-9.

Bhat RA, Khan I, Khan I, Palla N, Mir T. Emphysematous pyelonephritis: Outcome with conservative management. Indian J Nephrol. 2013;23: 444-7.






Case Reports