Fatal emphysematous pyelonephritis with gas in the spinal extradural space in a patient with diabetes

• Published in: Diabetic medicine Vol. 18; no. 1; pp. 68 - 71
• Main Authors: Sailesh, S., Randeva, H. S., Hillhouse, E. W., Patel, V.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.01.2001; Blackwell
• Subjects: Associated diseases and complications; Bacterial diseases; Bacterial diseases of the urinary system; Biological and medical sciences; diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - physiopathology; Emphysema - complications; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Escherichia coli Infections - complications; Fatal Outcome; Gases - analysis; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Muscle, Skeletal - diagnostic imaging; Muscle, Skeletal - pathology; Pyelonephritis - complications; Pyelonephritis - diagnosis; Spinal Cord - pathology; Tomography, X-Ray Computed; urinary tract infection; Urinary Tract Infections - complications; Endocrinopathy; Human; Kidney disease; Plain film; Urinary system disease; Radiodiagnosis; Male; Non insulin dependent diabetes; Ascending pyelonephritis; Case study; Infection; Pyelonephritis; Medical imagery; Adult; Diagnosis; Emphysema
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1046/j.1464-5491.2001.00402.x

SUMMARY Background  Emphysematous pyelonephritis (EP) is a rare but life‐threatening condition of the upper urinary tract, characterized by the presence of gas in the renal parenchyma and perirenal space. The vast majority of patients with EP (90%) are known to have diabetes, with Escherichia coli being the most common causative pathogen. Case report  We present a case of fatal bilateral EP in a patient with diabetes, with an unusual radiological finding of gas around the spinal cord and in the psoas muscle, with renal parenchymal sparing. Our case serves as an important reminder of this life threatening entity in diabetic patients, which is not well recognized by clinicians because of its rarity.