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Omoleye D, Israr MA, Tazin F, Habib S, Desai S, Go CC, Aranmolate A, Frontela O. Culture-Negative Emphysematous Pyelonephritis as a Complication of Uncontrolled Diabetes Mellitus: A Case Report. Cureus 2022; 14:e27856. [PMID: 36110486 PMCID: PMC9462396 DOI: 10.7759/cureus.27856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma. It is commonly found as a complication of uncontrolled diabetes mellitus (DM). EPN has a terrible prognosis unless promptly identified and treated. In this case study, a 38-year-old man with type 2 diabetes mellitus (T2DM) was admitted due to complaints of excruciating abdominal pain, vomiting, and non-adherent to his insulin medication. The patient was subsequently diagnosed with EPN. For most patients, the current course of treatment includes nephrectomy along with antimicrobial medications. In this case report, however, the patient improved with conservative treatment such as IV fluids, antibiotics, and blood glucose control.
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A review of anatomy, pathology, and disease spread in the perisplenic region. Abdom Radiol (NY) 2021; 46:805-817. [PMID: 32949273 DOI: 10.1007/s00261-020-02736-8] [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] [Received: 06/11/2020] [Revised: 08/18/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023]
Abstract
The perisplenic region is a complex anatomical area involving multiple peritoneal and subperitoneal structures, which influence the presentation and behavior of various pathologic processes. This review is a comprehensive resource for perisplenic anatomy and pathology with associated clinical presentations and imaging findings. Understanding the pathophysiologic intricacies of the perisplenic region assists the radiologist in building a helpful differential diagnosis and recognizing predictable disease patterns.
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Chávez-Valencia V, Orizaga-de-La-Cruz C, Aguilar-Bixano O, Lagunas-Rangel FA. Coexistence of emphysematous cystitis and bilateral emphysematous pyelonephritis: a case report and review of the literature. CEN Case Rep 2020; 9:313-317. [PMID: 32328853 DOI: 10.1007/s13730-020-00479-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/12/2020] [Indexed: 01/04/2023] Open
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.
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Affiliation(s)
- Venice Chávez-Valencia
- 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.
| | - Citlalli Orizaga-de-La-Cruz
- 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
| | - Omar Aguilar-Bixano
- 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
| | - Francisco Alejandro Lagunas-Rangel
- Department of Genetics and Molecular Biology, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV), Mexico, Mexico
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Ozawa M, Ichiyanagi O, Fujita S, Naito S, Fukuhara H, Suenaga S, Takai S, Narisawa T, Hosoya N, Ishii T, Yamanobe T, Muto A, Suzuki H, Nishida H, Kato T, Tsuchiya N. Risk of SOFA Deterioration in Conservative Treatment for Emphysematous Pyelonephritis: Pitfalls of Current Trends in Therapeutics from Multicenter Clinical Experience. Curr Urol 2019; 12:134-141. [PMID: 31316321 PMCID: PMC6613313 DOI: 10.1159/000489431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/20/2017] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION We investigated relationships between therapeutic outcomes of patients with emphysematous pyelonephritis (EPN) and changes in the Sequential Organ Failure Assessment (SOFA) score. MATERIALS AND METHODS We retrospectively evaluated EPN patients treated in our hospitals using the SOFA score incorporated in the Sepsis-3 updated in 2016. RESULTS Seventeen typical EPN patients were included in this study, and were treated with medical management with no drainage (n = 3), retrograde stenting (n = 10), or percutaneous drainage (n = 3). One patient without drainage died of sepsis, yielding an overall mortality rate of 5.9%. Twelve patients recovered without increase in the SOFA score during hospitalization. However, the SOFA score deteriorated in the other patients from admission, with the initial scores not significantly different from those of the 12 cases. The changes in the SOFA score were significantly affected by the selected approaches of drainage (100% patients for no drainage, 22% for stenting, and 0% for percutaneous drainage, p = 0.029), but not by other clinical data. CONCLUSION Most EPN patients can currently be conservatively managed successfully. However, it should be noted that less-invasive management could cause deterioration in SOFA after admission, yielding a risk of septic mortality.
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Affiliation(s)
- Michinobu Ozawa
- Department of Urology, Okitama Public General Hospital, Kawanishi, Japan
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Osamu Ichiyanagi
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Suguru Fujita
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
- Department of Urology, Nihonkai General Hospital, Yamagata, Japan
| | - Sei Naito
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroki Fukuhara
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
- Department of Urology, Nihonkai General Hospital, Yamagata, Japan
| | - Shinta Suenaga
- Department of Urology, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Japan
| | - Satoshi Takai
- Department of Urology, Okitama Public General Hospital, Kawanishi, Japan
| | - Takafumi Narisawa
- Department of Urology, Okitama Public General Hospital, Kawanishi, Japan
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Noriyuki Hosoya
- Department of Urology, Yamagata Prefectural Kahoku Hospital, Yamagata, Japan
| | - Tatsuya Ishii
- Department of Urology, South Miyagi Medical Center, Miyagi, Japan
- Department of Urology, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Takuya Yamanobe
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
- Department of Urology, Yamagata Prefectural Kahoku Hospital, Yamagata, Japan
| | - Akinori Muto
- Department of Urology, Yamagata Prefectural Shinjo Hospital, Shinjo, Japan
| | - Hitoshi Suzuki
- Department of Urology, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Hayato Nishida
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomoyuki Kato
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
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Bilateral emphysematous pyelonephritis cured by antibiotics alone in a black African woman. Radiol Case Rep 2018; 13:848-854. [PMID: 30002786 PMCID: PMC6040232 DOI: 10.1016/j.radcr.2018.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/24/2018] [Accepted: 05/26/2018] [Indexed: 12/27/2022] Open
Abstract
A 78-year-old black woman with a 10-year history of diabetes mellitus was admitted to the intensive care unit. Upon admission, she presented with chills, nausea, and left flank pain. The presence of hyperglycemia (fasting blood glucose, 19.7 mmol/L) and an altered consciousness required immediate treatment with insulin analog. Laboratory investigations and enhanced computed tomography scan led to the diagnosis of bilateral emphysematous pyelonephritis (EPN). The patient responded well to conservative treatment with antibiotics, and was finally discharged after 22 days when the computed tomography scan showed resolution of all the pockets of air. This case and associated literature review of 25 previously reported cases of bilateral EPN show the changing trend of EPN management from emergency nephrectomy toward conservative treatment with potent antibiotics and/or percutaneous drainage, and has been associated with higher survival rates compared to emergency nephrectomy.
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Tomar LR, Rajendran R, Pandey SK, Aggarwal A. Splenic abscess: Plasmodium vivax with secondary Escherichia coli infection. Trop Doct 2014; 45:143-5. [DOI: 10.1177/0049475514561507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Splenic abscess is a rare clinical entity as described in literature. The incidence is in the range of 0.14–0.7% and it has a high mortality rate. Hence, it is important to know its clinical presentation and complications, so that it can be treated early. We report a 40-year-old diabetic man who presented with fever with chills and rigor for the last 9 days and heaviness in the left hypochondrium for the last 6 days. He was initially diagnosed as having splenomegaly due to Plasmodium vivax ( P. vivax), but was later found to have a splenic abscess due to Escherichia coli ( E. coli). This was successfully managed by catheter drainage (CD) and antibiotic treatment.
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Affiliation(s)
- Laxmikant Ramkumarsingh Tomar
- Senior Resident, Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Ranjith Rajendran
- Postgraduate Resident, Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Santosh Kumar Pandey
- Postgraduate Resident, Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Amitesh Aggarwal
- Assistant Professor, Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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