Case Report

A case of emphysematous pyelonephritis induced by Citrobacter freundii infection Youichi Yanagawa, Yohei Hirano, Naoko Matsumoto1, Tatsuya Ogishima1 Department of Emergency Medicine and Disaster Medicine, Juntendo University Hospital, 1Department of Urology, Juntendo University Hospital, 3-1-3, Hongo Bunkyo-ku, Tokyo, Japan 113-8431

ABSTRACT A 79-year-old female with diabetes mellitus had general fatigue, a high fever and vomiting. A CT revealed acute emphysematous pyelonephritis (EPN). A nephrectomy was performed on the 2nd hospital day. The results of the blood culture showed the presence of Citrobacter freundii infection. The patient’s post-operative course was uneventful. This case is the second reported case of EPN induced by Citrobacter freundii. Bacteremia induced by Citrobacter freundii infection typically results in a high mortality rate. In this case, the early diagnosis of the EPN using CT and immediate medical treatment, including urgent elective nephrectomy, were key to the favorable outcome. Key Words: Citrobacter freundii, nephrectomy, pyelonephritis

INTRODUCTION Emphysematous pyelonephritis (EPN) is a rare disease. A history of diabetes mellitus and female gender are common predisposing factors.[1-3] In comparison with simple pyelonephritis, EPN is an acute severe necrotizing infection of the renal parenchyma, and is a life-threatening condition, with a mortality rate of up to 21%.[2] Among the reported cases of EPN, there has been the only one report of the disease induced by Citrobacter freundii infection.[4]

computed tomography (CT) scan for detection of the septic focus suggested acute emphysematous pyelonephritis (EPN) [Figure 1]. She was treated conservatively, however, her condition did not improve, so an urgent right nephrectomy was performed on the 2nd hospital day. The results of the blood and urine culture showed the presence of Citrobacter freundii infection. The patient’s post-operative course was uneventful and discharged on foot. This case is the second reported case of EPN induced by C. freundii. [4] Bacteremia induced by C. freundii infection

CASE REPORT A 79-year-old female with diabetes mellitus and hypertension had general fatigue, high fever and vomiting, was transferred to our hospital. She was experiencing a state of systemic inflammatory response syndrome and had lower abdominal tenderness. A Address for correspondence: Mr. Youichi Yanagawa, E-mail: [email protected] Access this article online Quick Response Code: Website: www.onlinejets.org

DOI: 10.4103/0974-2700.120380

Journal of Emergencies, Trauma, and Shock I 6:4 I Oct - Dec 2013

Figure 1: The abdominal CT scan on arrival. It indicates an air density (arrow) area in the right renal swelling parenchyma with dirty fat signs, suggesting acute emphysematous pyelonephritis 287

Yanagawa, et al.: Emphysematous pyelonephritis induced by Citrobacter freundii

typically results in a high mortality rate. In this case, early diagnosis of EPN using CT and immediate medical treatment, including urgent elective nephrectomy, was key to the favorable outcome. REFERENCES

3.

Somani BK, Nabi G, Thorpe P, Hussey J, Cook J, N’Dow J; ABACUS Research Group. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol 2008;179:1844-9.

4.

Fischer C, Kallerhoff M, Weidner W, Ringert RH. Citrobacter emphysematous pyelonephritis in a tuberculous kidney caused by citrobacter. A case report in a diabetic patient. Ann Urol (Paris) 1996;30:108-11.

1.

Dhabalia JV, Nelivigi GG, Kumar V, Gokhale A, Punia MS, Pujari N. Emphysematous pyelonephritis: Tertiary care center experience in management and review of the literature. Urol Int 2010;85:304-8.

How to cite this article: Yanagawa Y, Hirano Y, Matsumoto N, Ogishima T. A case of emphysematous pyelonephritis induced by Citrobacter freundii infection. J Emerg Trauma Shock 2013;6:287-8.

2.

Ubee SS, McGlynn L, Fordham M. Emphysematous pyelonephritis. BJU Int 2011;107:1474-8.

Received: 12.02.12. Accepted: 13.02.12. Source of Support: Nil. Conflict of Interest: None declared.

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Journal of Emergencies, Trauma, and Shock I 6:4 I Oct - Dec 2013

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A case of emphysematous pyelonephritis induced by Citrobacter freundii infection.

A 79-year-old female with diabetes mellitus had general fatigue, a high fever and vomiting. A CT revealed acute emphysematous pyelonephritis (EPN). A ...
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