title: [Emphysematous pyelonephritis. Case report].
abstract: OBJECTIVE
  To describe an unusual case of emphysematous pyelonephritis, a disease with high morbidity and mortality.
  
  
  METHODS
  We present the case of a 62-year old diabetic female with history of kidney stones, who consulted for fever, left lower-back pain and impairment of the general condition. Abdominopelvic computed tomography revealed a perinephric collection of air reaching the abdominal wall.
  
  
  RESULTS
  After initial medical management with antibiotics and general supportive measures, we performed an open incision and drainage. A week later, signs of sepsis reappeared and the left kidney was excised. The patient died two weeks later of septic shock.
  
  
  CONCLUSIONS
  This disease must be suspected in diabetic females with renal lithiasis and pyelonephritis not responding to treatment, and impaired general condition. Early diagnosis (computed tomography is the gold-standard) and supportive measures are essential for initial management. Surgery can be open (drainage, initial or deferred nephrectomy), percutaneous (nephrostomy) or endoscopic (double-J stent). Conservative management is a choice in bilateral or mild cases. Mortality rate is high and worsens with delayed therapy.
authors.affiliation: FUCDIM (Fundación Urológica Córdoba para la Docencia e Investigación Médica), Cordoba, Argentina. trisdellavedova@hotmail.com
authors.forename: Tristán
authors.initials: T
authors.lastname: Dellavedova
authors.forename: María Laura
authors.initials: ML
authors.lastname: Racca
authors.forename: Rolando
authors.initials: R
authors.lastname: Ponzano
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Sarría
authors.forename: Federico
authors.initials: F
authors.lastname: Minuzzi
authors.forename: Gustavo
authors.initials: G
authors.lastname: Minuzzi
mesh_terms: D004646:Emphysema / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011704:Pyelonephritis / Q000150:complications / Q000175:diagnosis / Q000628:therapy