Emphysematous pyelonephritis and cystitis: A case report and literature review

Abstract

This present case report describes a 64-year-old female patient with type 2 diabetes mellitus who also had emphysematous pyelonephritis (EPN) and emphysematous cystitis (EC). Computed tomography revealed well defined emphysematous pyelonephritis and cystitis. Broad-spectrum antibiotic and percutaneous drainage of the right kidney were used as part of a conservative management regimen. The patient achieved clinical recovery and was discharged 12 days after admission. Furthermore, 13 other cases of EPC and EC that were reported between 1962 and 2017 were reviewed and discussed. The overall mortality was 15.4% (two of 13 patients), compared with 25% for EPN alone or 7.4% for EC alone as reported in the literature. The primary pathogen identified in the 13 patients was Escherichia coli (53.8%). All 13 patients were treated with antibiotics.

Emphysematous Pyelonephritis Following Ureterovesical Reimplantation for Congenital Obstructive Megaureter. Pediatric Case Report and Review of the Literature

“…EPN is a rare and life threatening suppurative infection of the renal parenchymal and perirenal tissues, characterized by spontaneous gas production (13). Since the first case reported by Kelly and MacCallum (12) in 1898, more than 600 cases of EPN have been reported in the adult age (14–17). However, the first reported case in the literature regarding a pediatric patient was in 1985 in a 10-year-old female patient (6); and to date, as reported in Table 1, only seven other cases have been reported in children (6–11).…”

Concurrent emphysematous pyelonephritis (EPN) and emphysematous cystitis (EC) presenting with septic shock

“…Concurrent EPN and EC is a rare occurrence. These infections result from infection with gas-forming bacteria, most commonly in patients with uncontrolled DM 1. These infections have a high-mortality rate if left untreated 2.…”

“…CT scan is the most sensitive modality for diagnosis emphysematous urinary tract infections 3. Treatment approach includes systemic antibiotics, percutaneous catheter drainage and nephrectomy 1. Early recognition of this infection is prudent for early management, which can improve patient outcomes and potentially prevent more invasive interventions.…”

Emphysematous Cystitis; A Case Complicated with Bilateral Hydroureteronephrosis

“…Diabetes mellitus and urinary tract obstruction are the most important risk factors. A significant proportion of the patients are women over 60 years of age (2). Abdominal pain, dysuria, pollakiuria, and urgency symptoms might be seen in patients with emphysematous cystitis.…”

“…The diagnosis is made by imaging of the abdomen by direct radiography or computed tomography (CT) via detecting air in the bladder wall (3). Escherichia coli and Klebsiella pneumoniae are common isolated microorganisms (2). Bacteremia is generally observed in half of the cases.…”