title: A rare case of abdominal infection: Emphysematous pyelonephritis without diabetes.
abstract: Emphysematous pyelonephritis (EP) is a rare form of necrotizing pyelonephritis. It is a life-threatening condition that usually affects patients with diabetes, and a small percentage may be due to urinary tract obstruction. Here, we present the case of an EP caused by urinary tract obstruction without diabetes. A 45-year-old woman presented to the emergency department with fever, chills, and abdominal pain. There was no significant past history. Physical examination depicted bilateral lower abdominal and right flank knocking tenderness. Laboratory exams revealed leukocytosis, neutrophilia, a high C-reactive protein level, and pyuria. Abdominal computerized tomography (CT) showed diffuse gas in the right renal collecting system and dilatation of the right renal pelvis compared to the right side, in addition to multiple millimetric stones located in the right kidney and right ureter. After emergent placement of a percutaneous nephrostomy, she was admitted. Control abdominal CT without contrast revealed the absence of gas, hydronephrosis of the right renal pelvis, and the presence of nephrolithiasis. The patient was discharged 10 days of post-procedure with instructions for follow-up. Emergency physicians need to remain alert about this life-threatening disease and the typical CT findings of this disease to make a timely diagnosis and navigate management.
authors.affiliation: Emergency Department, Izmir Katip Çelebi University Atatürk Research and Training Hospital , İzmir , Turkey.
authors.forename: Erden Erol
authors.initials: EE
authors.lastname: Ünlüer
authors.affiliation: Emergency Department, Izmir Katip Çelebi University Atatürk Research and Training Hospital , İzmir , Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Şahı N
authors.affiliation: Radiology Department. İzmir Katip Çelebi University Atatürk Research and Training Hospital , İzmir , Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Oyar
authors.affiliation: Emergency Department, Izmir Katip Çelebi University Atatürk Research and Training Hospital , İzmir , Turkey.
authors.forename: Gözde Canan
authors.initials: GC
authors.lastname: Tan
authors.affiliation: Emergency Department, İzmir Karşıyaka State Hospital , İzmir , Turkey.
authors.forename: Arıf
authors.initials: A
authors.lastname: Karagöz
authors.affiliation: Urology Department, İzmir Katip Çelebi University Atatürk Research and Training Hospital , İzmir , Turkey.
authors.forename: Celaleddı N
authors.initials: CN
authors.lastname: Turan
keywords: emergency; emphysematous pyelonephritis; urinary obstruction