Systemic lupus erythematosus (SLE) is an autoimmune disease characterised by the production of antibodies to components of the cell nucleus in association with a diverse array of clinical manifestations. When the immune system attacks its own tissues, it causes widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. The primary pathological findings in patients with SLE are those of inflammation, vasculitis, immune complex deposition, and vasculopathy.Late-onset SLE represents a specific subgroup of SLE and is often initially missed leading to a significant delay in diagnosis. Elderly patients frequently present to hospital with nonspecific symptoms such as fatigue, recurrent fever of an unknown cause, weight loss, serositis (pleural and/or pericardial effusions), and acute kidney injury.We are describing a case of late onset SLE in a male patient that has been previously only syptomaticaly treated for the complications of the disease itself, whilst it took a longer period for physicians to think of SLE and make further investigations about it, because of the age and sex of the patient.
Emphysematous pyelonephritis (EPN) is a rare, severe, spontaneous gas-forming infection of renal parenchyma and its surrounding areas. EPN was detected in diabetic patients. A 49-year-old female with type I diabetes mellitus presented with severe thrombocytopenia, acute kidney injury (AKI) and was in need of haemodialysis treatment. She had impaired liver function tests, with active urine sediment, indicating severe upper urinary tract infection with suspected sepsis. The contrast enhanced CT scan of the abdomen showed multiple areas of air density in renal parenchyma and perirenal regions, suggestive of left-side EPN. The blood and urine cultures reported growth of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli. The final diagnosis of emphysematous pyelonephritis complicated with severe sepsis and AKI was established. The patient was managed conservatively with wide-spectrum antibiotics, fluid resuscitation, consistent blood sugar control, and haemodialysis treatment. Percutaneous drainage techniques (PCD) and nephrectomy were postponed because of the initial clinical response to the antibiotics treatment. However, the patient experienced sudden clinical deterioration and died only a few hours after the established diagnosis. An autopsy was not performed upon the patient’s family’s request. EPN should be highly suspected in poorly controlled diabetic patients with urinary tract infection and should be promptly recognized and aggressively treated. The patients with multiple risk factors had high mortality, even with timely diagnosis and combined (conservative and surgical) treatment.
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