Abstract
Emphysematous pyelonephritis (EPN) is a life-threatening infectious disease that requires surgical intervention. The clinical condition mimics acute pyelonephritis, but EPN is almost exclusively accompanied by diabetes mellitus, especially poorly controlled diabetes. CT is considered to be the most useful diagnostic tool. A 69-year-old man was transferred to our hospital complaining abdominal pain. He presented with septic shock, disseminated intravascular coagulation, acute kidney failure and hyperglycemia. He was diagnosed acute pyelonephritis by a CT examination. Because the hemoglobin A1c level was found to be 12.6%, we thoroughly reevaluated the CT findings to rule out the possibility of EPN but could not detect any renal gas. Though the patient's septic shock temporarily reversed by intensive care, his abdominal pain and hypoxemia rapidly progressed following paroxysmal atrial fibrillation. We performed a second CT examination to exclude the possibility of a mesenteric artery embolism, and incidentally observed EPN. The patient underwent a left radical nephrectomy and overcame the crisis. In patients with urosepsis and poorly controlled diabetes accompanied by septic shock, an abdominal CT examination is highly recommended, even if the septic shock has been temporarily reversed, to rule out the possibility of EPN.
