The
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Emphysematous Pyelonephritis
Chih-Yen Chen, M.D. Taipei Medical University New Taipei City, Taiwan
Chi-Jen Chen, M.D. Shuang Ho Hospital New Taipei City, Taiwan [email protected]
A
67-year-old woman with diabetes and poor glycemic control who had recently been treated for pyelonephritis presented to the emergency department in septic shock. She had a 2-day history of fever, flank pain, lethargy, and confusion. Blood tests showed leukocytosis and hyperglycemia. Urinary microscopy revealed pyuria. A scout image was obtained with the use of unenhanced computed tomography. The image revealed extensive gas collection in the parenchyma and perinephric space of the left kidney (arrows) and the left renal vein, with corresponding hydronephrosis and hydroureter. These findings and her symptoms suggested emphysematous pyelonephritis. Immediate radical nephrectomy was performed. Escherichia coli was found on blood cultures, and a course of piperacillin–tazobactam was administered. Despite intraoperative perforation of the bladder, which required surgical repair, the patient had a good postoperative recovery and remained well after the completion of antibiotic treatment, with good glycemic control. Elevated tissue levels of glucose in patients with diabetes may create a more favorable environment for gas-forming bacteria.
DOI: 10.1056/NEJMicm1314314 Copyright © 2014 Massachusetts Medical Society.
e34
n engl j med 371;22
nejm.org
november 27, 2014
The New England Journal of Medicine Downloaded from nejm.org at UNIV OF UTAH ECCLES on November 27, 2014. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Emphysematous Pyelonephritis
Chih-Yen Chen, M.D. Taipei Medical University New Taipei City, Taiwan
Chi-Jen Chen, M.D. Shuang Ho Hospital New Taipei City, Taiwan [email protected]
A
67-year-old woman with diabetes and poor glycemic control who had recently been treated for pyelonephritis presented to the emergency department in septic shock. She had a 2-day history of fever, flank pain, lethargy, and confusion. Blood tests showed leukocytosis and hyperglycemia. Urinary microscopy revealed pyuria. A scout image was obtained with the use of unenhanced computed tomography. The image revealed extensive gas collection in the parenchyma and perinephric space of the left kidney (arrows) and the left renal vein, with corresponding hydronephrosis and hydroureter. These findings and her symptoms suggested emphysematous pyelonephritis. Immediate radical nephrectomy was performed. Escherichia coli was found on blood cultures, and a course of piperacillin–tazobactam was administered. Despite intraoperative perforation of the bladder, which required surgical repair, the patient had a good postoperative recovery and remained well after the completion of antibiotic treatment, with good glycemic control. Elevated tissue levels of glucose in patients with diabetes may create a more favorable environment for gas-forming bacteria.
DOI: 10.1056/NEJMicm1314314 Copyright © 2014 Massachusetts Medical Society.
e34
n engl j med 371;22
nejm.org
november 27, 2014
The New England Journal of Medicine Downloaded from nejm.org at UNIV OF UTAH ECCLES on November 27, 2014. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
