“Fatal” gas in the kidney

Excerpt

A 56-year-old diabetic woman with 3-day history of urinary tract infection taking oral antibiotics presented with a sudden consciousness disturbance. On examination, a febrile (38.8°C) patient with a blood pressure of 83/48 mmHg and a heart rate of 120/min was seen. Laboratory studies revealed a leukocyte count of 11.0 × 10⁹/l with band neutrophils of 22%. Urinalysis showed pyuria with 40–50 leukocytes per low-power field. Escherichia coli were found in both blood and urine cultures. The computed tomography scan disclosed massive gas collections within (arrowheads) and around (arrows) the enlarged right kidney (Fig. 1a, b), establishing the diagnosis of emphysematous pyelonephritis. Despite emergent radical nephrectomy with potent intravenous antibiotics, the patient expired due to septic shock 10 h postoperatively.

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