title: Bilateral extensive emphysematous pyelonephritis. A case report.
abstract: OBJECTIVE
  We report a case involving a patient with bi- lateral emphysematous pyelonephritis (EPN) who was successfully treated with antibiotics and nephrostomy sparing nephrectomy.
  
  
  METHODS
  A 54-year-old diabetic man presented with the chief complaint of progressive abdominal pain for 10 days. Blood tests indicated acute renal failure and hyperglycemic hyperosmolar state. An abdominal radiograph disclosed gas distributed over regions where the bilateral kidneys are located and the right para-lumbosacral area. Computed tomography revealed bilateral enlarged kidneys with the presence of gas in the renal parenchyma and renal pelvis, left peri-renal space, bilateral ureter, bladder, prostate gland and right scrotum. Cultures of urine and blood grew Escherichia coli. The patient was successfully treated with antibiotics coupled with nephrostomy.
  
  
  CONCLUSIONS
  Timely recognition and initiation of effective antibiotic therapy and nephrostomy may cure the patient with bilateral EPN, while sparing nephrectomy. Regarding clinical manifestations, EPN is nonspecific; hence, radiographs should be taken for diabetic patients with abdominal pain (especially those with poorly controlled blood sugar) to enable early diagnosis of potential EPN.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ing-Kit
authors.initials: IK
authors.lastname: Lee
authors.forename: Ching-Jung
authors.initials: CJ
authors.lastname: Hsieh
authors.forename: Jien-Wei
authors.initials: JW
authors.lastname: Liu
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D048909:Diabetes Complications; D004646:Emphysema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011704:Pyelonephritis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D011859:Radiography; D015898:Tomography Scanners, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents