Title: Emphysematous Pyelonephritis with Extensive Myonecrosis: A Case Report
Authors: Rajesh G. Halarnakar, Prashant T.N. Mandrekar, Pankaj D. Chari, Veku A. Gaude, Maria Amanda L. Cardoso, Nilesh B. Talwadker, Prashant R. Lawande, Madhumohan R. Prabhudessai
DOI: https://dx.doi.org/10.18535/jmscr/v7i12.53
Abstract
Emphysematous pyelonephritis (EPN) is a urologic emergency characterized by an acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens. This is a case report of a 60 year old female who presented to Goa Medical College with lower abdominal pain, vomiting and inability to walk. On CT scan patient was diagnosed to have bilateral emphysematous pyelonephritis with extension of air into posterior abdominal wall, right gluteal region and right thigh. On examination patient had tenderness in both lumbar and suprapubic region with crepitation over right lower abdomen, back, right gluteal region and right thigh. CT scan revealed bilateral emphysematous pyelonephritis with extension of air into the pelvis, posterior abdominal wall, right gluteal region and right thigh. Blood tests showed leucocytosis with thrombocytopenia with arterial blood gas analysis showing metabolic acidosis. Emergency percutaneous nephrostomy was done bilaterally. Patient subsequently underwent cystocopy with Right DJ Stenting with Left nephrectomy with desloughing and release incision of right buttock, back & right thigh. Bilateral EPN with extensive myonecrosis is a rare and extremely serious, life threatening condition requiring aggressive management. Aggressive management is needed in the form of wide desloughing and nephrectomy.
Keywords: Emphysematous pyelonephritis, myonecrosis, nephrectomy
References
- Kelly HA, MacCallum WG. Pneumaturia. JAMA 1898; 31 : 375 – 81.
- Schultz EH Jr, Klorfein EH. Emphysematous Pyelonephritis. J Urol 1962;87:762‑6
- Chen MT, Huang CN, Chou YH, Huang CH, Chiang CP, Liu GC: Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience. J Urol 1997; 157:1569–1573.
- Huang JJ, Tseng CC: Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med 2000; 160: 797–805.
- Wan YL, Lee TY, Bullard MJ, Tsai CC: Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology 1996; 198: 433–438.
- Chen KW, H uang JJ, Wu MH, e t al. G as in hepatic veins: a rare and critical presentation of emphysematous pyelonephritis . J Urol 1994 ; 151 : 125 – 6.
- Lin DC, Shieh GS, Tong YC. Bilateral emphysematous pyelonephritis combined with subcapsular hematoma and disseminated necrotizing fasciitis. Urol Int 2003;70:244–6.
- Ishigami K, Bolton-Smith JA, DeYoung BR, Barloon TJ. Necrotizing fasciitis caused by xanthogranulomatous and emphysematous pyelonephritis: importance of the inferior lumbar triangle pathway. AJR Am J Roentgenol 2004;183: 1708–10.
- Amitai A, Sinert R. Necrotizing fasciitis as the clinical presentation of a retroperitoneal abscess. J Emerg Med 2008;34:37–40.
- Yu-Xiong Ye, Yao-Ko Wen. Emphysematous Pyelonephritis Presenting as Necrotizing Fasciitis of the Leg. J Chin Med Assoc March 2009 • Vol 72 • No 3
- Yasuda T, Tani Y. Necrotizing fasciitis caused by emphysematous pyelonephritis through iliopsoas abscess. J Orthop Sci 2011; 16:832‑5.