Emphysematous Pyelonephritis and Emphysematous Cholecystitis: A Result of Uncontrolled Type 2 Diabetes

Abstract

Background: Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing infection that results in the presence of gas in the renal parenchyma, collecting system, and surrounding tissues. Up to 95% of patients with EPN have underlying uncontrolled diabetes mellitus. Emphysematous cholecystitis (EC) is a necrotizing infection defined by the presence of gas in the gallbladder. Concurrent presentation of EPN and EC is limited to anecdotal cases in the literature. Case Report: We present the case of a 44-year-old female who arrived at the emergency department with signs of septic shock and diffuse abdominal pain. Diagnosis of EPN and EC was confirmed. Because the patient did not improve after aggressive medical therapy and percutaneous drainage and cholecystostomy, she was taken to surgery for emergency nephrectomy and cholecystectomy. Conclusion:In unusually extensive and severe cases of EPN, medical and minimally invasive procedures are not enough to control the infection. More aggressive management, including emergency surgery, should be implemented in selected patients who present with refractory septic shock associated with extensive disease.

Culture-Negative Emphysematous Pyelonephritis as a Complication of Uncontrolled Diabetes Mellitus: A Case Report

“…Gram-negative bacteria such as E. Coli are the most common pathogen, responsible for this infection. The underlying factors include high tissue glucose levels, which compromise tissue perfusion, and impaired neutrophil activity found in diabetic patients [2,7].…”

“…Gram-negative bacteria such as E. Coli are the most common pathogen, responsible for this infection. The underlying factors include high tissue glucose levels, which compromise tissue perfusion, and impaired neutrophil activity found in diabetic patients [ 2 , 7 ]. According to a meta-analysis, only 5-10.2% of EPNs are bilateral, with 52% of cases affecting the left kidney and 37.7% in the right [ 8 ].…”

“…Emphysematous pyelonephritis (EPN) is an acute bacterial infection in the parenchymal region of the kidneys [1,2]. The most common pathogens involved are Escherichia coli (E. coli), Klebsiella pneumoniae, Proteus mirabilis, Clostridium septicum, Candida albicans, and Pseudomonas [3].…”

“…The most common pathogens involved are Escherichia coli (E. coli), Klebsiella pneumoniae, Proteus mirabilis, Clostridium septicum, Candida albicans, and Pseudomonas [3]. In a favorable environment, these organisms cause fermentation of glucose and lactate to carbon dioxide which develops a necrotizing infection in the perinephric fat of the kidney [1,2]. Almost 90% of cases are found as a complication of uncontrolled diabetes mellitus (DM) or due to medication non-adherence [1,2].…”

“…In a favorable environment, these organisms cause fermentation of glucose and lactate to carbon dioxide which develops a necrotizing infection in the perinephric fat of the kidney [1,2]. Almost 90% of cases are found as a complication of uncontrolled diabetes mellitus (DM) or due to medication non-adherence [1,2]. Since patients with uncontrolled diabetes tend to have elevated blood sugar and glucosuria, these organisms, particularly E. coli thrive greatly in this environment.…”