Necrotising fasciitis from fulminant pyelonephritis

Abstract

Emphysematous pyelonephritis (EPN) is a severe urinary tract infection (UTI) that causes kidney necrosis by gas‐producing bacteria. Escherichia coli is most implicated. Type‐2 diabetes mellitus (T2DM) is a common predisposing factor. Necrotising fasciitis (NF) is an uncommon complication of EPN that has severe consequences. It is easily missed due to rarity. We present the case of an 82‐year‐old female nursing home resident with T2DM that presents with NF of the left flank following EPN of the left kidney that has penetrated through the superior lumbar triangle. This is the first time this anatomical pathway has been implicated in NF secondary to EPN in the English literature.

Emphysematous pyelonephritis with progression to necrotising fasciitis of the posterior cervical region and the retropharyngeal space

“…There should be a high level of suspicion for necrotising fasciitis if a patient presents with urinary tract infection and flank cellulitis. The threshold for a CT scan is kept low as necrotising fasciitis may already be developing from an emphysematous kidney 6. A CT scan is a crucial investigation in the diagnosis and confirmation of both emphysematous pyelonephritis and necrotising fasciitis 6…”

“…The threshold for a CT scan is kept low as necrotising fasciitis may already be developing from an emphysematous kidney 6. A CT scan is a crucial investigation in the diagnosis and confirmation of both emphysematous pyelonephritis and necrotising fasciitis 6…”

Emphysematous Pyelonephritis Complicated by Necrotising Fasciitis and Massive Pulmonary Embolus: A Regional Australian Experience

“…The prognosis of emphysematous pyelonephritis depends on CT scan findings and has four classification grades (Table 1) [4]. On reviewing the literature (Pubmed, MEDLINE, and Google Scholar) five case reports which discussed cases of necrotising fasciitis secondary to emphysematous pyelonephritis were found [6][7][8][9][10]. In four of the five cases, the patients were women; all five patients had diabetes mellitus.…”

“…On reviewing the literature (Pubmed, MEDLINE, and Google Scholar) five case reports which discussed cases of necrotising fasciitis secondary to emphysematous pyelonephritis were found [ 6 - 10 ]. In four of the five cases, the patients were women; all five patients had diabetes mellitus.…”