Emphysematous pyelonephritis in an alcoholic and diabetic patient

  • Chih-Hsuan Wang
    Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan (R.O.C.)
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  • Chi-Hao Liu
    Corresponding author: Dr. Chi-Hao Liu MD, Division of Nephrology, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City 80284, Taiwan (R.O.C.)
    Division of Nephrology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan (R.O.C.)
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Published:September 24, 2022DOI:


      A 56-year-old man with chronic uncontrolled diabetes mellitus and alcoholism who presented to our hospital with fever and progressive lethargy for 2 days. The blood test showed leukocytosis, hyperglycemia, poor renal function, and extremely high procalcitonin level. He presented the bubbly and mottled bowel gas pattern over left lower abdominal region in the chest X-ray . That warned us the something wrong in the abdomen. Computed tomography of abdomen was arranged and found left emphysematous pyelonephritis. Then, he received broad-spectrum antibiotic treatment and underwent retroperitoneal exploration operation with drainage of abscess. Finally, the infection was under-controlled. Emphysematous pyelonephritis is defined as an acute, severe gas-forming infection of renal parenchyma, and perirenal tissue. It is such a life-threatening condition which needs urgent medical and surgical intervention. And It is easy to miss the diagnosis due to nonspecific gas pattern in plain radiograph. Especially, the patient was vagrant and had no complaints of abdominal or flank pain, which made the diagnosis challenging.


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