2023 Volume 66 Issue 5 Pages 326-332
The patient was a 62-year-old woman with an 18-year history of type 2 diabetes mellitus who had discontinued treatment for 2 years due to interrupted to hospital visits. She was brought to the emergency department of our hospital with a fever of 39.6°C and impaired consciousness (JCS 300). She was diagnosed with a hyperosmolar hyperglycemic condition (HHS) and acute pyelonephritis of the right kidney due to Klebsiella aerogenes infection. Her severe sepsis was treated with multidisciplinary care in the ICU from the time of admission, and although the HHS improved, there was a flare-up of inflammation on the 7th day. Reevaluation by contrast-enhanced CT revealed findings of acute focal bacterial nephritis (AFBN), and suggested possible progression to renal abscess in some parts. Surgical treatment was considered for AFBN and renal abscess refractory to medical treatment. Percutaneous drainage was difficult due to the location of the abscess; thus, right nephrectomy was performed on the 10th day, and her general condition improved promptly thereafter. We should reevaluate acute pyelonephritis refractory to medical treatment with contrast-enhanced CT and consider surgical treatment in cases with progression to AFBN or renal abscess.
