Case 4 :
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A 38 year old diabetic with history of fever and left loin pain, and a cell count of 23,000.
What is the diagnosis?

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Emphysematous Pyelonephritis



Emphysematous pyelonephritis is a fulminating infection involving the kidney and peri-renal tissues with gas formation, abscesses and tissue necrosis. Almost all patients are diabetics and usually ill and septic. Common pathogens include E. Coli and Proteus, rarely anaerobic organisms like Clostridia may be involved.

This diagnosis is based on the presence of gas seen within the interstitium of the renal parenchyma. If the lesion is confined to the collecting system (emphysematous pyelitis), perinephric spaces (perinephric abscess), or within a focal area (abscess), it is not a true case of emphysematous pyelonephritis.

CT studies show a lace like pattern of air within the renal interstitium, as well as inflammatory component and necrotic destruction.

This condition has a high morbidity and mortality; usually complications like renal obstruction or perinephric abscesses may need a nephrostomy, and/or percutaneous or surgical drainage of infected fluid collections, sometimes a nephrectomy may be needed.



Dr. Ashok Raghavan, Manipal, Karnataka