Emphysematous pyelonephritis caused by candida species: A case report and outcome of 1 year follow-up

Report on the diagnosis and treatment of 3 cases of emphysematous pyelonephritis with two different outcomes

Background

Emphysematous pyelonephritis (EPN) is a rare acute severe necrotising infection of the kidneys in clinical practice. It is characterized by the presence of gas in the renal parenchyma, collecting system, or perirenal tissue. The prognosis is poor, with a high nephrectomy rate and a mortality rate of up to 20-40%.

Methods

Retrospective analysis of 3 cases of emphysematous pyelonephritis with two different outcomes.

Results

Three patients who we described were all female with diabetes mellitus, and their blood sugar was poorly controlled. One patient with the advanced age and poor general health died due to the patient's family choosing to terminate therapy. Two patients underwent surgical procedures achieved an excellent clinical recovery. Both of them underwent percutaneous nephrostomy and perinephric abscess puncture drainage before nephrectomy. Escherichia coli were the microorganisms implicated.

Conclusion

EPN is a rare and severe urinary system infection. Computed tomography (CT) and microbiological culture confirmed the diagnosis. Control of diabetes, sensitive antibiotic therapy, fluid resuscitation and prompt surgical intervention are crucial.

Diagnosing and Managing Urinary Tract Infections in Kidney Transplant Recipients

In the article, the authors review antibiotic treatment options for both acute uncomplicated UTI and complicated UTI. In addition, they review alternative regimens which are needed in the setting of drug-resistant pathogens including vancomycin-resistant Enterococcus, -extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales, and carbapenem-resistant Pseudomonas, which are encountered with more frequency.

Mucosal emphysematous head and neck infections: Scoping review and a case of emphysematous tonsillitis

Objective

This scoping review seeks to understand the existing research in otolaryngological mucosal emphysematous infections and to elucidate gaps in knowledge in the field. We also present a case of bilateral necrotizing tonsillitis in an immunocompromised patient with the first reported imaging findings of emphysematous abscess of the tonsils.

Data Sources

PubMed, Embase, Web of Science.

Review Methods

We conducted our review according to the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews. Patient presentation, management, and outcomes were summarized. We also describe the case of a patient with aplastic anemia found to have emphysematous tonsillitis, managed with intubation, broad spectrum intravenous antibiotics and bilateral tonsillectomy.

Results

We identified seven case reports or series, involving nine total patients, who presented with emphysematous epiglottitis, supraglottitis, or tonsillitis. The hallmark imaging characteristic was submucosal "gas bubble" on computed tomography. Presenting symptoms included dysphagia, odynophagia, dysphonia, cough, and fever. Both immunocompetent and immunocompromised patients were affected. All patients were treated with broad spectrum antibiotics, and most with steroids. Patients at risk of airway compromise also underwent intubation and surgical drainage or debridement of the emphysematous infection.

Conclusion

Emphysematous pharyngeal infections are rare but potentially life-threatening infections that can progress rapidly, resulting in airway compromise and sepsis in both immunocompetent and immunocompromised individuals. We highlight the importance of swift intervention, with intubation and surgical intervention often required for severe cases. More research is needed on common pathogens and patient risk factors to guide future medical and surgical management.

A Rare Case of Complicated Emphysematous Pyelonephritis

Emphysematous pyelonephritis is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma, collecting system, or perinephric tissue. The management of emphysematous pyelonephritis mainly depends on the extent of the disease. In this report, we present the case of a 48-year-old male who presented with left flank pain and imaging findings of left-sided emphysematous pyelonephritis with extensions of air into the pararenal space as well as a 5.6 cm bladder stone and severe right-sided hydroureteronephrosis. He initially received bilateral nephrostomy tubes, a left-sided perinephric draining tube, and intravenous antibiotics; however, his symptoms persisted. Ultimately, the patient underwent open cystolitholapaxy and left nephrectomy, with eventual resolution of symptoms.

Emphysematous pyelonephritis: Six case reports and review of literature

BACKGROUND

Emphysematous pyelonephritis (EPN) is a severe acute necrotizing infection of the renal parenchyma and surrounding tissues that causes the presence of gas in the renal parenchyma, collecting system, or perinephric tissue and has a poor prognosis. EPN occurs primarily in people with diabetes mellitus (DM), but can occur in those without DM when the associated renoureteral unit is obstructed.

CASE SUMMARY

We describe our experience with six patients who developed EPN. Five patients had DM, including one with diabetic ketoacidosis, one with multisystem involvements, including eye, lung and brain. Bilateral urolithiasis was present in one case, along with emphysematous cystitis. Unilateral kidney stones were present in one patient. One patient was an older man in poor general health. Five individuals survived and underwent surgical procedures including ureteral stent installation (Double J stent placement), percutaneous nephrostomy and perinephric abscess puncture drainage, while one died because the patient’s family chose to terminate therapy. Klebsiella pneumoniae and Escherichia coli were the microorganisms implicated.

CONCLUSION

We conclude that EPN is a potentially fatal illness. A positive outcome necessitates early detection. Therapeutic measures should be implemented as soon as a diagnosis is made.

Emphysematous pyelonephritis: experience at a tertiary care hospital in Bangladesh

BACKGROUND

Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues, characterized by gas accumulation. We describe clinical, laboratory and imaging characteristics and in-hospital outcomes of patients with EPN.

METHODS

This retrospective observational study was carried out at BIRDEM General Hospital, Dhaka, Bangladesh between 2014 and 2020.

RESULTS

We followed 20 patients (mean age 49.4 years; females 70%). Risk factors for EPN were diabetes mellitus (in 100%) and renal stones (in 10%). Fever, loin pain, vomiting and dysuria were common. Complications included acute kidney injury (AKI, 70%; mostly stage 1, 78.6%), hyponatraemia (55%) and bacteraemia (15%). Escherichia coli was the most common (60%) urinary isolate. Most patients (80%) had class 2 EPN, with 15% class 3B and 5% class 3A. Besides medical management, four (20%) required surgery (nephrectomy in 3). Nephrectomised patients had a higher radiological class (p = 0.032) and incidence of AKI (p = 0.034). No deaths occurred.

CONCLUSION

EPN occurred predominantly in female diabetic patients, who presented with fever, loin pain, vomiting and dysuria. Two-thirds of patients had AKI and one-fifth required surgery, and there were no deaths.

Candidal emphysematous pyelonephritis: A case report on rare and challenging clinical entity

INTRODUCTION

Emphysematous pyelonephritis is a rare, severe acute necrotizing infection characterized by the presence of gas within the renal parenchyma, collecting system, and perirenal tissue. It is an aggressive disease with high morbidity and mortality. Patients have female preponderance and commonly have uncontrolled diabetes. It is caused most commonly by Escherichia coli and very rarely by Candida species. Unlike others, candidal emphysematous pyelonephritis has an indistinctive presentation and diagnosed late, thus delaying prompt treatment.

CASE PRESENTATION

A 35-year-old Type 2 diabetic woman developed pyelonephritis. Computerized tomography revealed the gas in the renal parenchyma, establishing the diagnosis. Cultures isolated Candida albicans as a causative organism. The patient was treated successfully with nephrectomy as initial medical therapy and percutaneous nephrostomy failed.

CONCLUSION

Rare causative agent should be suspected if clinical presentation is indistinctive and conservative management fails. Nephrectomy is still preferred in such patients.