Emphysematous Pyelonephritis in a Patient With Hyperosmolar Hyperglycemic Syndrome

Abstract

A 61-year-old woman presented with abdominal and back pain, and disturbed consciousness. Laboratory data showed hyperglycemia (plasma glucose 448 mg/dl), leukocytosis, thrombocytopenia, renal failure, and extremely increased serum C-reactive protein level. Urinalysis revealed no ketone bodies, and numerous bacteria and leukocytes. These symptoms and data suggested the presence of diabetic hyperosmolar hyperglycemic syndrome and urinary tract infection. Computed tomography (CT) of the abdomen showed the presence of gas in the renal area with extensive renal parenchymal destruction, indicating the diagnosis of emphysematous pyelonephritis, which is a rare but severe disease with a morality rate that can be as high as 70%. Early diagnosis by abdominal CT and early intensive therapy using intensive insulin therapy, antibiotics, and selective nephrectomy saved her life.




J Med Cases. 2011;2(1):37-38
doi: https://doi.org/10.4021/jmc121w