An Uncommon Complication of Emphysematous Cystitis and Pyelitis.

Psoas muscle abscesses associated with emphysematous urinary tract infections are rare. There are not many case reports about urinary tract infections such as emphysematous pyelitis and emphysematous cystitis complicating psoas muscle abscesses. Here, we report a case of an ipsilateral psoas muscle abscess following emphysematous cystitis and emphysematous pyelitis in an 81-year-old diabetic man. He was treated with prolonged antibiotic therapy and other supportive care.

Bilateral emphysematous pyelitis: a rare encounter in urology.

Gas-forming infection of the kidneys can affect either the parenchyma or the collecting system. They are known as emphysematous pyelonephritis (EPN) and emphysematous pyelitis (EP) respectively. Bilateral EPN is a fairly established entity and numerous articles about this condition have been published. However, much less is known about bilateral EP. We report a rare case of bilateral EP and a literature review of this disease. A 66-year-old woman with long-standing bilateral staghorn calculi presented with bilateral EP and severe sepsis. She was treated with antibiotics and bilateral double-J stents to drain the upper urinary tracts. She recovered after 1 month of intensive care and medical therapy. Percutaneous nephrolithotomy (PCNL) had been scheduled to treat her staghorn calculi. A literature search on MEDLINE and Google Scholar with the terms "bilateral emphysematous pyelitis" only found 1 case report in English and another 2 reports in the Korean language that discussed bilateral EP. The collective experience of these few cases, including the present case, suggests that bilateral EP runs a more benign course than bilateral EPN. It should be diagnosed as soon as possible with computed tomography (CT) scans of the renal system. Current evidence shows that can be treated successfully with timely antibiotics. Drainage of the collecting system either percutaneously or with placement of double-J stents might facilitate recovery.

Pielite enfisematosa unilateral: relato de caso / Unilateral emphysematous pyelitis: case report

The present report describes the case of a 22-year-old female patient admitted to the emergency room with acute low back pain, dysuria, vomiting and fever (38.5ºC). Urinalysis and computed tomography findings revealed urinary tract infection associated with presence of gas in the collecting system, characterizing unilateral emphysematous pyelitis caused by Gram-negative bacteria. The present case report emphasizes the occurrence of this disease as a urinary tract infection complication.

Relata-se um caso de paciente de 22 anos de idade, gênero feminino, que foi admitida no pronto-socorro com lombalgia aguda, disúria, vômitos e febre (38,5ºC). Os achados de exames de urina e tomografia computadorizada demonstraram infecção no trato urinário associada a gás no sistema coletor, configurando pielite enfisematosa unilateral por Gram-negativo. O presente relato enfatiza a ocorrência deste agravo como complicação de infecção no trato urinário.

Emphysematous urinoma as a complication of emphysematous pyelitis in a healthy adult male.

Emphysematous pyelitis and urinomas are independently rare conditions. The former is a severe necrotizing infection involving the renal collecting system, the latter an encapsulated collection of urine in the perinephric or paraureteral space. An unusual case of emphysematous urinoma complicating emphysematous pyelitis in a healthy male adult is presented in this study.

Clinics in diagnostic imaging (138). Emphysematous pyelitis.

We present the case of a 49-year-old woman with poorly controlled diabetes mellitus of ten years' duration. She presented to the emergency department with nonspecific left lower abdominal pain. Ultrasonography showed mild left renal hydronephrosis, but the cause was not demonstrated. Computed tomography (CT) showed a swollen left kidney with a mildly dilated collecting system containing gas and dense fluid, confirming the diagnosis of emphysematous pyelitis. Management consisted of emergency antegrade nephrostomy drainage and parenteral antibiotics. Subsequently, the patient made a good recovery and was well when discharged home after two weeks. Gas-forming infections of the genitourinary tract carry high mortality and morbidity, and usually occur in patients with poorly controlled diabetes mellitus. Escherichia coli is the most common microorganism. This case emphasises the importance of CT in making an early diagnosis of emphysematous pyelitis, which allows prompt treatment and improves prognosis.

Emphysematous pyelitis: epidemiological, therapeutic and evolutive features.

AIM: Emphysematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis. METHODS: The data of six patients managed for emphysematous pyelitis were collected and analyzed. RESULTS: The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned -- dedifferentiated -- renal parenchyma. Outcome was good. CONCLUSION: Emphysematous pyelonephritis is a rare upper urinary tract infection. Risk factors include diabetes and urinary obstruction. The diagnosis is made by computed tomography. Efficient antibiotics administration associated with collecting system drainage allow soon recovery and avoid nephrectomy.

[Encrusted pyelitis: early diagnosis facilitates conservative management]. / Pyélite incrustante: un diagnostic précoce facilite la prise en charge conservatrice.

Diagnosis of encrusted pyelitis in predisposed patients is difficult. The bacteriology laboratory must be specifically asked to perform the appropriate tests. Computed tomography without injection is very important for diagnosis and follow-up. Conservative treatment is essential insofar as possible. Long-term follow-up is also necessary.

Alkaline encrusted pyelitis.

Alkaline encrusted pyelitis is an infectious disease characterised by encrustations in the wall of the upper urinary tract, surrounded by severe inflammation. Destruction of native kidneys and kidney grafts may occur, resulting in end stage renal failure. Corynebacterium group D2, an urea splitting microorganism, is nearly exclusively associated with this disease. The most important predisposing factors are previous urological procedures and an immunosuppressed state. In a suggestive clinical context, diagnosis should be made with unenhanced computed tomography findings and bacteriologic isolation of the responsible microorganism. The treatment is threefold: appropriate antibiotic therapy, by preference with glycopeptides, acidification of urine and chemolysis, and if needed, surgical removal of encrustations. We report the case of a patient who was diagnosed with this rare condition and could escape maintenance dialysis after correct diagnosis was made and conservative treatment was started using antibiotics and combined oral and local acidification.

[Encrusted pyelitis in a transplanted kidney]. / Pielitis incrustante en riñón trasplantado.

OBJECTIVES: To emphasize the importance of early diagnosis of encrusted pyelitis in kidney transplant patients. METHODS: We report one case of encrusted pyelitis in a 10-year-old girl with a kidney graft who was treated by means of nephrostomy tube irrigation with an acidifier liquid substance. RESULTS: After 16 days of treatment there was a significant decrease of the size of the calcified pyelic plaque, keeping a good renal function afterwards. CONCLUSIONS: This disease should be thought of in every case of kidney transplant patient with negative urine cultures and alkaline pH, and the microbiologist should be alerted of the possibility of urinary tract infection by Corynebacterium.