Coexistence of emphysematous cystitis and bilateral emphysematous pyelonephritis: a case report and review of the litera
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CASE REPORT
Coexistence of emphysematous cystitis and bilateral emphysematous pyelonephritis: a case report and review of the literature Venice Chávez‑Valencia1 · Citlalli Orizaga‑de‑La‑Cruz1 · Omar Aguilar‑Bixano1 · Francisco Alejandro Lagunas‑Rangel2 Received: 30 November 2019 / Accepted: 12 April 2020 © Japanese Society of Nephrology 2020
Abstract Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. Meanwhile, emphysematous cystitis (EC) is a clinical entity characterized by the presence of gas inside and around the bladder wall. Interestingly, although both diseases are common in patients with diabetes mellitus, these are rarely combined. We report a rare case of a 56-year-old diabetic male suffering from fever, headache and vomiting and in which a diagnosis of septic shock was established due to coexistence of EC and bilateral EPN. The emphysematous diseases improved with a conservative treatment approach using antibiotic therapy and glycemic control, we highlight that the nephrectomy was not necessary in our patient despite the fact that he presented risk factors that predict the failure of conservative treatment. Keywords Emphysematous pyelonephritis · Emphysematous cystitis · Computed tomography · Type 2 diabetes mellitus · Septic shock
Introduction Diabetes mellitus is a chronic disease whose treatment has traditionally focused on glycemic control, but accumulating evidence suggests that the clinical management of patients requires a more comprehensive approach to minimize associated morbidity and mortality [1]. In this way, patients with diabetes are more prone to get urinary tract infection (UTI), because high levels of urine sugar provide a pathogenfriendly growth environment, where emphysematous pyelonephritis (EPN), emphysematous cystitis (EC), renal and perinephric abscesses, urosepsis, and bacteremia are some common complications, although these are rarely combined.
* Venice Chávez‑Valencia [email protected] 1
Department of Nephrology, Hospital General Regional Hospital No 1, Instituto Mexicano del Seguro Social, Bosques de los Olivos No. 101. Av. La Goleta Mpo Charo, CP: 61301 Morelia, Michoacán, Mexico
Department of Genetics and Molecular Biology, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV), Mexico, Mexico
2
Emphysematous pyelonephritis has been defined as a necrotizing infection of the renal parenchyma and its surroundings that results in the presence of gas in the renal parenchyma, collecting system or perinephrotic tissues [2]. Meanwhile, emphysematous cystitis is a clinical entity, characterized by the presence of gas inside and around the bladder wall produced by bacterial or fungal fermentation [3]. Here, we present a rare case of EC and bilateral EPN coexistence in a 56-year-old male who was successfully managed with medical treatment.
Case report A 56-year-old male patient presented to the department of nep
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