A case report of emphysematous pyelonephritis as a first presentation of diabetes mellitus

Aerococcus viridans pyelonephritis in a young age female patient with type 1 diabetes mellitus: a rare case report

Background

Aerococcus species are Gram-positive cocci, with negative catalase and oxidase activities and growth characteristics similar to viridans streptococci. They rarely cause infection in humans. However, there are reports of bacteremia, meningitis, septic arthritis, and endocarditis due to this pathogen in the literature. Herein we report a rare case of pyelonephritis due to A. viridans.

Case presentation

A 31-year-old-female patient with type 1 diabetes mellitus was presented with left loin pain, fever, nausea, and anorexia for 3 days. She had a history of obstructive nephropathy due to sloughed necrotic papillae 3 months earlier, mandating bilateral JJ stent insertion. She was treated with a 2 weeks course of doxycycline (100 mg, twice daily) based on the antibiotic susceptibility profile of her urine culture and responded well.

Conclusion

This case highlights the possibility of complicated urinary tracts infection due to a rare human pathogen.

Emphysematous pyelonephritis: Is nephrectomy warranted?

INTRODUCTION

Emphysematous pyelonephritis (EPN) is associated with high mortality rate, up to 25%. There is still conflicting reports regarding the most appropriate management, conservative versus nephrectomy.

OBJECTIVE

To describe the outcome of patients with EPN.

METHODS

We retrospectively reviewed the medical records of patients diagnosed with EPN by computed tomography from three tertiary institutes in Jeddah, Saudi Arabia. Type of management was classified as conservative and surgical. The conservative includes medical and minimally invasive procedures, such as percutaneous drainage and nephrostomy. The surgical which is nephrectomy. The outcome observed was preservation of the kidney function or patient's life.

RESULTS

A total of 10 patients were included (9 females and 1 male), median age was 55 years and 63% were diabetic. The most common presentation was flank pain (100%), fever (75%), and vomiting (63%). The most common organism isolated was Escherichia coli. Nephrectomy was not associated with increased survival rate, while conservative management was associated with a good outcome, less morbidity (not dialysis-dependent).

CONCLUSION

Nephrectomy was not associated with high survival rate. Patients managed conservatively had a better overall performance and better survival. This study will add to other studies, which are encouraging conservative management.