DOI: http://dx.doi.org/10.18203/2349-3933.ijam20174309

Emphysematous pyelonephritis presenting in acute respiratory distress syndrome: a case report

Robin George Manappallil, Abdul Azeez, Anoop Kumar, Ganga Prasad, Mele Chelakkoth Sabir

Abstract


Emphysematous pyelonephritis is a life-threatening infection of the kidneys characterized by acute necrosis with associated gas formation involving the renal parenchyma and perinephric tissues. It is a rare condition and occurs mostly in diabetic females, carrying a high mortality rate. The management involves antibiotics and surgical interventions. This is a case of an elderly lady, diabetic, who had fever and burning micturition and was initially treated with oral antibiotics. She later presented with fever, dyspnoea and dysuria, and was diagnosed to have emphysematous pyelonephritis with acute respiratory distress syndrome. She was successfully managed with broad spectrum antibiotics and percutaneous nephrostomy. As emphysematous pyelonephritis requires both medical and surgical interventions, this case, therefore, highlights the importance of its early detection, as it can be life-saving.


Keywords


Acute respiratory distress syndrome, Dysuria, Diabetes mellitus, Emphysematous pyelonephritis

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References


Gupta K, Trautner BW. Urinary tract infections, pyelonephritis, and prostatitis. In: Kasper, Fauci, Hauser, Longo, Jameson, Loscalzo (ed). Harrison’s Principles of Internal Medicine. 19th ed. McGraw Hill education. 2015;861-863.

Kelly HA, MacCallum WG. Pneumaturia. J Am Med Assoc. 1898;31(8):375-81.

Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinico radiological classification, management, prognosis, and pathogenesis. Archives of Internal Medicine. 2000;160(6):797-805.

Wang JM, Lim HK, Pang KK. Emphysematous pyelonephritis. Scandinavian Journal of Urology and Nephrology. 2007;41(3):223-9.

Tseng CC, Wu JJ, Wang MC, Hor LI, Ko YH, Huang JJ. Host and bacterial virulence factors predisposing to emphysematous pyelonephritis. Am J Kidney Dis. 2005;46(3):432-9.

Leons SMH, Abu S. Emphysematous pyelonephritis: case report. Kuwait Med J. 2004;36(2):134-6.

Huang JJ, Chen KW, Ruaan MK. Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection. J Urol. 1991;146(1):148-51.

Michaeli J, Mogle P, Perlberg S, Heiman S, Caine M. Emphysematous pyelonephritis. J Urol. 1984;131(2):203-8.

Kim MJ, Park JS, Lim HJ, Jung J, Shin DG, Lee KD, et al. Emphysematous pyelonephritis caused by Citrobacter freundii in a patient with type 2 diabetes and neurogenic bladder. Infect Chemother. 2013;45(3):331-4.

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

Vivek V, Panda A, Devasia A. Emphysematous pyelonephritis in a renal transplant recipient- is it possible to salvage the graft? Ann Transplant. 2011;17(3):138-41.

Tang HJ, Li CM, Yen MY, Chen YS, Wann SR, Lin HH, et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. 2001;34(2):125-30.

Ahlering TE, Boyd SD, Hamilton CL, Bragin SD, Chandrasoma PT, Lieskovsky G, et al. Emphysematous pyelonephritis: a 5-year experience with 13 patients. J Urol. 1985;134(6):1086-8.