title: Emphysematous Pyelonephritis Caused by Citrobacter freundii in a Patient with Type 2 Diabetes and Neurogenic Bladder.
abstract: Emphysematous pyelonephritis (EPN) is a rare, life-threatening complication of upper urinary tract infections that is characterized by the presence of gas in the renal parenchyma and perirenal space. It commonly occurs in diabetic patients. Escherichia coli are the most common causative organisms, with few reports implicating Citrobacter freundii as the etiologic agent in EPN. A 57-year-old woman with diabetes and neurogenic bladder visited at our department with confused mentality, myalgia, and general weakness. Further investigation revealed that the patient suffered from unilateral EPN with sepsis caused by C. freundii. The patient's condition was improved considerably with percutaneous drainage and use of intravenous antibiotics for several weeks. However, renal function eventually deteriorated to permanent renal failure, which required hemodialysis. In conclusion, C. freundii may be the causative pathogen of EPN in a patient with type 2 diabetes and neurogenic bladder.
authors.affiliation: Department of Internal Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Min Jeong
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Ji Sang
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Jihye
authors.initials: J
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Dong Geum
authors.initials: DG
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Ki-Deok
authors.initials: KD
authors.lastname: Lee
authors.affiliation: Department of Radiology, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Yoon Young
authors.initials: YY
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Kyung Wan
authors.initials: KW
authors.lastname: Min
authors.affiliation: Department of Internal Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Kyung-Ah
authors.initials: KA
authors.lastname: Han
keywords: Citrobacter freundii; Diabetes mellitus; Emphysematous pyelonephritis