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Balagobi B, Gobishangar S, Heerthikan K, Priyatharsan K, Nalayini J, Jenil A. Case report on bilateral emphysematous pyelonephritis in a non-diabetic male: A complex treatment journey. Int J Surg Case Rep 2024; 114:109122. [PMID: 38100932 PMCID: PMC10762345 DOI: 10.1016/j.ijscr.2023.109122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis is a severe kidney infection characterized by gas formation, predominantly affecting diabetic women. Symptoms include fever, pain, and nausea, requiring urgent and accurate management due to its potentially fatal nature. CASE PRESENTATION This article reports a successful management of a case of bilateral emphysematous pyelonephritis complicated with perinephric, retroperitoneal collection and urosepsis. DISCUSSION Emphysematous pyelonephritis (EPN) is a severe kidney infection characterized by acute necrotizing infection in the renal tissue and nearby structures. While EPN typically affects individuals with risk factors such as diabetes, obstructive uropathy, and hypertension, this case is unique because the patient lacks these common risk factors but hails from a region where EPN is more prevalent. The management of EPN has evolved over the years, with recent advances in imaging, antibiotics, and drainage techniques leading to a shift from invasive surgical procedures to more conservative approaches, resulting in improved outcomes and reduced mortality rates. CONCLUSION Emphysematous pyelonephritis demands urgent intervention to prevent high mortality rates. Swift, tailored treatment, including antibiotics and possible surgical interventions, is crucial, involving a multidisciplinary approach for improved patient outcomes.
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Affiliation(s)
- B Balagobi
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka.
| | - S Gobishangar
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
| | - K Heerthikan
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
| | - K Priyatharsan
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
| | | | - A Jenil
- Department of Radiology, Teaching Hospital Jaffna, Sri Lanka
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Jin M, Fan Z, Gao R, Li X, Gao Z, Wang Z. Research progress on complications of Brucellosis. Front Cell Infect Microbiol 2023; 13:1136674. [PMID: 37065189 PMCID: PMC10102637 DOI: 10.3389/fcimb.2023.1136674] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
Brucellosis is a common zoonotic disease that is widely spread worldwide and poses a major threat to human health. Clinically, it often presents with non-specific symptoms such as fever, excessive sweating, malaise, myalgia, arthralgia, loss of appetite, weight loss, and enlarged liver, spleen and lymph nodes. The disease has a long and recurrent course, often accumulating in multiple systems and organs. Of these, osteoarticular involvement is the most common complication, with a prevalence of approximately 2-77%, usually manifesting as spondylitis, sacroiliac arthritis and peripheral arthritis. Hepatosplenomegaly is seen in about 50% of patients with brucellosis, and gastrointestinal disturbances such as abdominal pain, nausea, and vomiting are common. Although respiratory involvement is less common, pneumonia, pleurisy, pleural effusion, and pulmonary nodules have been reported. Besides, approximately 2-20% of cases involve infections of the male genitourinary system, mainly manifesting as unilateral epididymal-orchitis and orchitis. The most serious complication facing brucellosis is cardiovascular involvement, and although the overall mortality rate of brucellosis is about 1% and the incidence of brucellosis endocarditis is less than 2%, more than 80% of deaths are associated with endocarditis. Furthermore, brucellosis is complicated by hematologic disease, with anemia occurring in approximately 20-53% of children during the acute phase. In addition, the neurological incidence of brucellosis is about 0.5-25%, mainly manifested as meningitis. In this study, we review the multisystem complications of brucellosis with the aim of improving early diagnosis, timely treatment and prevention of long-term complications.
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Affiliation(s)
- Min Jin
- School of Public Health, Baotou Medical College, Baotou, China
- Collaborative Innovation Center of Zoonotic Diseases and Translational Medicine, Baotou Medical College, Baotou, China
| | - Zixu Fan
- School of Public Health, Baotou Medical College, Baotou, China
| | - Ruifang Gao
- School of Public Health, Baotou Medical College, Baotou, China
| | - Xingnan Li
- School of Public Health, Baotou Medical College, Baotou, China
| | - Zhixiang Gao
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
- *Correspondence: Zhixiang Gao, ; Zhanli Wang,
| | - Zhanli Wang
- Inner Mongolia Key Laboratory of Disease-Related Biomarkers, The Second Affiliated Hospital, Baotou Medical College, Baotou, China
- *Correspondence: Zhixiang Gao, ; Zhanli Wang,
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Hsu CK, Wu SY, Yang SD, Chang SJ. Emphysematous pyelonephritis: classification, management, and prognosis. Tzu Chi Med J 2022; 34:297-302. [PMID: 35912050 PMCID: PMC9333110 DOI: 10.4103/tcmj.tcmj_257_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/28/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022] Open
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Commentary to 'Mini PCNL: A viable single stage treatment for pediatric nephrolthiasis in lower socioecnomic countries'. J Pediatr Urol 2021; 17:389. [PMID: 33849792 DOI: 10.1016/j.jpurol.2021.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/21/2022]
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Fassari A, Polistena A, De Toma G, Fiori E. An unusual case of genital filariasis of the testicular tunics in an Italian patient. Ann Saudi Med 2021; 41:186-189. [PMID: 34085543 PMCID: PMC8176374 DOI: 10.5144/0256-4947.2021.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
At least 27 million men present with urogenital manifestations of genital filariasis (GF). Although there is a large burden of GF in residents in endemic regions, infection in short-term travellers and in non-endemic areas is rare. We report the case of a 75-year-old Italian man referred to our institution for a testicular discomfort. Clinical examination and ultrasound detected a mass of 40×18 mm in the scrotum without signs of varicocele, hydrocele and testicular or epididymal abnormalities. After ineffective medical treatment, the patient underwent surgical excision. Histology demonstrated filarial granuloma with thick cuticles pathognomonic of an adult worm in the testicular tunics. Surgery has a fundamental role in localized cases of GF to remove nematodes from the fibrotic nodules. The present manuscript describes a singular case of GF observed in Italy in a non-immigrant patient with evidence of remnants of an adult worm in the testicular tunics. SIMILAR CASES PUBLISHED: 11.
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Affiliation(s)
- Alessia Fassari
- From the Department of Surgery Pietro Valdoni, Umberto I Policlinico, Roma, Italy
| | - Andrea Polistena
- From the Department of Surgery Pietro Valdoni, Umberto I Policlinico, Roma, Italy
| | - Giorgio De Toma
- From the Department of Surgery Pietro Valdoni, Umberto I Policlinico, Roma, Italy
| | - Enrico Fiori
- From the Department of Surgery Pietro Valdoni, Umberto I Policlinico, Roma, Italy
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Xing ZX, Yang H, Zhang W, Wang Y, Wang CS, Chen T, Chen HJ. Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review. World J Clin Cases 2021; 9:2584-2594. [PMID: 33889624 PMCID: PMC8040185 DOI: 10.12998/wjcc.v9.i11.2584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/04/2021] [Accepted: 02/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a rare but fatal necrotic infection of the kidney, which usually leads to septic shock. Therefore, early diagnosis and optimized therapy are of paramount importance. In the past two decades, point-of-care ultrasound (POCUS) has been widely used in clinical practice, especially in emergency and critical care settings, and helps to rapidly identify the source of infection in sepsis. We report a rare case in which a “falls” sign on POCUS played a pivotal role in the early diagnosis of EPN.
CASE SUMMARY A 57-year-old man presented with fever and lumbago for 3 d prior to admission. He went to the emergency room, and the initial POCUS detected gas bubbles in the hepatorenal space showing a hyperechoic focus with dirty shadowing and comet-tail artifacts. This imaging feature was like a mini waterfall. His blood and urine culture demonstrated Escherichia coli bacteremia, and EPN associated with septic shock was diagnosed. The patient did not respond to broad-spectrum antibiotic treatment and a perirenal abscess developed. He subsequently underwent computed tomography-guided percutaneous catheter drainage, and fully recovered. We also review the literature on the sonographic features of POCUS in EPN.
CONCLUSION This case indicates that a “falls” sign on POCUS facilitates the rapid diagnosis of severe EPN at the bedside.
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Affiliation(s)
- Zhou-Xiong Xing
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Hang Yang
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Wen Zhang
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Yu Wang
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Chang-Sheng Wang
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Tao Chen
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Hua-Jun Chen
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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Ma S, Wang X, Wang M, Liu Z, Li Z. A retrospective survey of Brucella melitensis human infection in Hainan Province, China. BIOSAFETY AND HEALTH 2021. [DOI: 10.1016/j.bsheal.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Sivaraj V, Ahamed A, Artykov R, Menon-Johansson A. Epididymitis and its aetiologies in a central London sexual health clinic. Int J STD AIDS 2020; 32:96-99. [PMID: 33292092 DOI: 10.1177/0956462420963879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epididymitis is a common cause of scrotal pain presentation in sexual health clinics; however, it is unclear what fraction is attributable to transmissible infections. We, therefore, reviewed the aetiologies causing epididymitis. A retrospective data analysis of all cases of epididymitis diagnosed from January 2018 to December 2018 in three sexual health clinics was conducted, collecting demographics, results, management and symptom resolution at two weeks follow up. A total of 127 cases of epididymitis (mean age 32 years, heterosexual 97, MSM 30) were included. Among them 14 cases (11%) were caused by sexual transmitted infections (<35 years n = 9; >35 years n = 5): seven cases of chlamydia, six gonorrhoea, one syphilis and one trichomonas vaginalis. There were three cases of urinary tract infection diagnosed. All cases were treated with antibiotics recommended by the British Association for Sexual Health and HIV (BASHH). At two weeks follow up post-treatment 10 (7%) were symptomatic; 91% did not attend for follow up. Sexually transmitted infections were associated with acute epididymitis in 11% of this study cohort.
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Affiliation(s)
| | - Azraan Ahamed
- Sexual Health Department, Guy's & St. Thomas NHS Foundation Trust, London, UK
| | - Ruslan Artykov
- Sexual Health Department, Guy's & St. Thomas NHS Foundation Trust, London, UK
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Guven S, Mert A. Infections in urology: slow progress reflected in clinical practice. World J Urol 2020; 38:2667-2668. [DOI: 10.1007/s00345-020-03473-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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