title: Emphysematous pyelonephritis (class IIIa) managed with antibiotics alone.
abstract: A 54-year-old male with long-standing diabetes presented with vague left flank pain for 5 days with uncontrolled blood glucose. The patient was commenced on insulin and injectable ceftriaxone empirically, for possibly acute pyelonephritis. Ultrasound examination revealed extensive emphysematous pyelonephritis of upper half of left kidney with involvement of perinephric space. Computed tomography of abdomen confirmed the diagnosis of emphysematous pyelonephritis which was categorised as class IIIa. The recommended treatment for class IIIa emphysematous pyelonephritis is nephrectomy but the patient refused to give consent for surgery or even percutaneous drainage. Thus, the patient was continued on medical management alone and surprisingly showed marked recovery over the next few days. There were no new complications, and the patient was discharged after 2 weeks of antibiotics with 2 more weeks of oral antibiotics. After 4 months, the ultrasound showed normal kidneys. We present this case because it adds to the little existing evidence that conservative management can successfully cure patients with class IIIa emphysematous pyelonephritis, although supplementation with percutaneous drainage would have been better in this case.
authors.affiliation: Department of Medicine, Dr RPGMC Kangra at Tanda, Kangra, 176001, Himachal Pradesh, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Chauhan
authors.affiliation: Department of Medicine, Dr RPGMC Kangra at Tanda, Kangra, 176001, Himachal Pradesh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sharma
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use*; D003928:Diabetic Nephropathies / Q000145:classification / Q000188:drug therapy* / Q000473:pathology; D004646:Emphysema / Q000145:classification / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011704:Pyelonephritis / Q000145:classification / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D002443:Ceftriaxone
keywords: Anti-bacterial agents; Emphysema/complications; Pyelonephritis/complications