A Rare Gas-Producing Infection of the Renal Pelvis

​BY Dhimitri A. Nikolla, DOAn 82-year-old man with a history of dementia, multiple urinary tract infections, insulin-dependent diabetes mellitus, and an admission a month earlier for Fournier gangrene presented to the emergency department with reports of confusion and hypotension from his nursing home. His vital signs were normal, but he was disoriented with a mildly tender abdomen. His genital examination revealed a suprapubic catheter without evidence of soft tissue infection. A CT with contrast of the abdomen and pelvis revealed the images shown.​What is the diagnosis? What is the treatment?The CT images demonstrated a left casting calculus extending into the proximal ureter with air in the renal pelvis consistent with emphysematous pyelitis. Vancomycin, piperacillin/tazobactam, and ceftriaxone were started in the ED based on his previous urine cultures and sensitivities. Later that day, the patient received a left ureteral stent. Urine cultures eventually grew Klebsiella pneumoniae, Escherichia coli, Enterococcus faecalis, and Candida tropicalis with multiple resistances. He was discharged after five days with cefdinir, amoxicillin, and fluconazole, but received a left percutaneous nephrostomy tube 17 days after ED presentation due to persistent hydronephrosis.Emphysematous pyelitis is a gas-producing infection of the renal pelvis. It is rarely reported in the literature, possibly because it is not always recognized as its own entity but as a subtype of emphysematous ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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