Presentation
History of uncontrolled diabetes mellitus, with left flank pain and deteriorating renal function. Treated for pyelonephritis, without significant clincal response.
Patient Data
Enlargement of left kidney, with destruction of the upper parenchyma. Renal and peri-renal fluid collections containing bubbly streaks of gas are also seen, as well as adjacent fat stranding and local reactive lymph nodes, configuring a case of type 2 emphysematous pyelonephritis.
Additional findings include protective ileostomy (history of rectal cancer), left pleural effusion and accessory spleen. Residual contrast media is present in the colon following previous barium enema.
Case Discussion
Emphysematous pyelonephritis is a life-threatening infectious disease of the renal parenchyma caused by gas-producing bacteria.
Up to 90% of the cases occur in patients with poorly controlled diabetes mellitus 1-2. Another risk factor is obstruction of the collective system 2.
Most common bacterial causative source is Escherichia coli, with Klebsiella pneumoniae and Proteus mirabilis representing most of the non-E. coli related cases 2.
Without proper treatment the condition usually evolves rapidly to a fulminant sepsis, with a high mortality rate.
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