A rare case of emphysematous pyelonephritis caused by Candida parapsilosis and Finegoldia magna complicated by medical c
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CASE REPORT
A rare case of emphysematous pyelonephritis caused by Candida parapsilosis and Finegoldia magna complicated by medical care avoidance Bridget C. Krol1 · Ashok K. Hemal2 · Elena M. Fenu3 · Heath T. Blankenship3 · Ram A. Pathak2 Received: 5 July 2020 / Accepted: 30 August 2020 © Japanese Society of Nephrology 2020
Abstract Emphysematous pyelonephritis (EPN) is a necrotizing gas producing infection of the renal parenchyma that commonly occurs in patients with diabetes. EPN requires early diagnosis and treatment due to the possible life-threatening septic complications. We report a rare case of EPN caused by an unfavorable mixed infection of Candida parapsilosis and Finegoldia magna. To our knowledge, this is the first reported case of EPN caused by Finegoldia magna. A 62-year-old male with diabetes mellitus (DM) presented with abdominal pain, shortness of breath, and nausea in which a diagnosis of septic shock was made due to EPN. Our patient first noticed abdominal pain 3 weeks prior to hospital presentation; however, he avoided getting treatment due to a fear of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This patient exhibited deterioration and expired after surgical intervention despite uneventful nephrectomy. This case suggests that medical care avoidance behaviors among patients could potentially complicate their clinical course. Keywords Emphysematous pyelonephritis · Candida parapsilosis · Finegoldia magna · COVID-19 · Pandemic · Severe acute respiratory syndrome coronavirus 2
Introduction Emphysematous pyelonephritis (EPN) is a severe necrotizing infection that results in gas production in the renal parenchyma, collecting system, and perinephric tissue [1]. * Bridget C. Krol [email protected] Ashok K. Hemal [email protected] Elena M. Fenu [email protected] Heath T. Blankenship [email protected] Ram A. Pathak [email protected] 1
Wake Forest School of Medicine, 475 Vine St, Winston‑Salem, NC 27101, USA
2
Department of Urology, Wake Forest School of Medicine, 140 Charlois Blvd, Winston‑Salem, NC 27103, USA
3
Department of Pathology, Wake Forest School of Medicine, Medical Center Boulevard, Winston‑Salem, NC 27157, USA
Gram-negative bacteria, such as Escheria coli and Klebsiella, are the most common causative pathogens of EPN [1]. Type 2 DM is the most common associated factor, followed by obstructive uropathy [2]. Up to 90% of all cases of EPN occur in patients with uncontrolled diabetes mellitus [3]. Computed Tomography (CT) is recommended for the evaluation of this disease and early nephrectomy is considered the treatment of choice, especially if a patient has a poor prognosis [1]. If not recognized and treated promptly, the clinical course of EPN can be life-threatening. A recent phenomenon of medical care avoidance among patients with life threatening illnesses, due to a fear of contracting coronavirus disease 2019 (COVID-19) during their hospital stay, is associated with misconceptions regarding disease severity and modes of
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