Bilateral Emphysematous Pyelonephritis in a Non-Diabetic Man Undergoing Peritoneal Dialysis

Tun-Kai Chuang ； Yin-Chou Hsu

《E-Da Medical Journal》 8卷4期 (2021/12) Pp. 24-28

https://doi.org/10.6966/EDMJ.202112_8(4).0004

摘要

Emphysematous pyelonephritis (EPN) is a rare but potentially life-threatening disease requiring prompt treatment. EPN with bilateral kidney involvement represents the rarest and most serious form of EPN. We report a middle-aged non-diabetic man undergoing continuous ambulatory peritoneal dialysis who presented to the emergency department with low-grade fever and fluctuations in consciousness. Abdominal computed tomography revealed gas accumulation in bilateral renal cortex, collecting systems, and bladder. Under the impression of bilateral EPN, he received broad-spectrum antibiotics and underwent bilateral percutaneous nephrostomy. He was discharged after six weeks of hospitalization. Poorly controlled diabetes mellitus with high glucose levels and obstructed urinary tract are common features in the majority of EPN cases. Although both factors were not observed in our patient, chronic dialysis with immunocompromised status and high-glucose dialysate exposure predisposed him to EPN development. The diagnosis of EPN is often delayed because of its nonspecific presentations. EPN treatment focuses on fluid resuscitation, electrolyte replacement, and antibiotic coverage. Regarding treatment, percutaneous drainage is required for specific types of EPNs and nephrectomy is considered the last-resort. Clinicians should have a high index of suspicion for this rare but serious infection.

關鍵字

computed tomography ； emergency department ； emphysematous pyelonephritis ； peritoneal dialysis

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