Solitary tubercular renal cyst in a postpartum lady masquerading as an infected giant renal cyst with urosepsis.

Renal tuberculosis presenting as renal cyst is rare. Diagnosing renal tuberculosis in pregnancy is usually delayed due to its atypical presentation. We present a 28-year-old postpartum lady who delivered a healthy baby one month back, with history of intermittent fever and chills. She had high spiking fever (102° F), tachycardia (130/min) and computed tomography showed a 16 × 10 cm right renal cyst. Percutaneous drainage was done, 2 litres of thick pus drained and culture was sterile. After three weeks, deroofing and marsupialization of cyst was done. Biopsy revealed granulomatous inflammation composed of epitheliod histiocytes with central incipient necrosis suggestive of tuberculosis. She was treated with anti-tubercular drugs. As the infant was healthy and had no evidence of tuberculosis, no treatment was initiated. The mother is on follow up for 2 years. This case highlights the rare presentation of renal tuberculosis in puerperium.

Emphysematous Pyelonephritis Presenting as Pneumomediastinum: A Rare Case Scenario.

Emphysematous pyelonephritis (EPN) is characterized by fulminant necrotizing infection of the kidney and perirenal tissues. Emphysematous pyelonephritis presenting as pneumomediastinum is quite rare. A 65-year-old gentleman presented to us with respiratory failure on ventilator support and uncontrolled sugars. He had fever with chills, abdominal pain, and breathlessness. He was evaluated and computed tomography showed right Huang et al. class 3 EPN with pneumomediastinum. He also had renal failure, respiratory distress syndrome, and metabolic acidosis. Pigtail drainage of right EPN was performed. He succumbed to the disease despite treatment. This case highlights the rare presentation of EPN as pneumomediastinum. HOW TO CITE THIS ARTICLE: Karthikeyan VS, Mohan V, Narayanan J, Karthikeyan A. Emphysematous Pyelonephritis Presenting as Pneumomediastinum: A Rare Case Scenario. Indian J Crit Care Med 2020;24(4):281-282.

Dengue shock syndrome after percutaneous nephrolithotomy leading to hematuria and renal failure: A rare complication.

Hematuria following percutaneous nephrolithotomy (PCNL) is a dreaded complication. It necessitates blood transfusion in up to 10% of patients. It may be severe enough in <1% of patients to require angioembolization. We present a 50-year-old male who underwent PCNL for renal pelvic calculus. Since the day of the surgery, he had low-grade fever (100°F) which worsened (102°F) from the 2nd postoperative day. His preoperative urine culture was sterile. His platelet counts started dropping and NS1 antigen for dengue was positive. He also developed anemia (hemoglobin: 7g%) and platelet counts dropped to 17,000/cmm. He developed anuria on the 7th postoperative day, with serum creatinine rising to 7 mg%. He required two sessions of hemodialysis and urine output improved. There is a need for high index of suspicion for dengue, especially when fever and hematuria coexist in post PCNL patients.

Isolated flat desmoid-type terminal ileal mesenteric fibromatosis masquerading as lower ureteric stricture-an intraoperative surprise.

Ureteral strictures are usually caused by ureteral calculi, endoscopic instrumentation, infections like tuberculosis, surgical dissection, radiation, malignancy and periureteral fibrosis. A 42-year-old man presented with right loin pain 2 months previously. Contrast-enhanced computed tomography showed right lower ureteral stricture and he was scheduled for right ureteral reimplantation. Intraoperatively, a large hard mass arising from the mesentery of the terminal ileum infiltrating the retroperitoneum and encasing the right external iliac artery, vein and ureter was identified. The mass was resected and psoas hitch was performed over a 5F (26 cm) double J stent. Patient was discharged on tenth postoperative day and is still doing well at 18 months of follow up period. We are reporting this case to highlight the rare possibility of mesenteric fibromatosis and its management.