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Emphysematous pyelonephritis

      A 70-year-old female with poorly controlled diabetes mellitus was admitted to the emergency department. She had a complaint of syncope, fever, general malaise, dysuria, and abdominal pain for 20 days. The patient's body temperature was 38.9 °C. Percussion in the right flank region elicited pain. Her laboratory tests were significant for the following: white cell count, 24.37 109 /L, with 92% segmented neutrophils; glucose, 18.80 mmol/L; glycosylated hemoglobin, 11.3%; blood urea nitrogen, 38 mmol/L; creatinine, 530 μmol/L. C-reactive protein, 176.4 mg/L.
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