A Case of Emphysematous Pyelonephritis Complicating Diabetes Mellitus

Abstract

A 67-year-old man had a 20-year history of diabetes mellitus. His deabetic condition had been controlled fairly well before and after admission. Left emphysematous pyelonephritis was incidentally found during examinations to determine the cause of prolonged anorexia. He had no continuous fever, pain or oliguria. Gas was clearly observed in the renal parenchyma and perirenal space on abdominal plain film and abdominal CT. No stenosis or obstruction of the renal vein and artery of the affected side was demonstrated by angiographical examination. Culture of pus from the perirenal space revealed Klebsiella pneumoniae. Drainage under ultrasonographic guidance and antibiotics were effective in this case and conservative therapy was continued for several months. Surgical therapy has been performed in most previously reported cases of emphysematous pyelonephritis because of the rapid exacerbation of symptoms and relatively poor prognosis. However, recent progress in antibiotics and the spread of interventional techniques with ultrasound may permit the choice of conservative therapy in many cases.