RESUMO
Background: Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing infection that results in the presence of gas in the renal parenchyma, collecting system, and surrounding tissues. Up to 95% of patients with EPN have underlying uncontrolled diabetes mellitus. Emphysematous cholecystitis (EC) is a necrotizing infection defined by the presence of gas in the gallbladder. Concurrent presentation of EPN and EC is limited to anecdotal cases in the literature. Case Report: We present the case of a 44-year-old female who arrived at the emergency department with signs of septic shock and diffuse abdominal pain. Diagnosis of EPN and EC was confirmed. Because the patient did not improve after aggressive medical therapy and percutaneous drainage and cholecystostomy, she was taken to surgery for emergency nephrectomy and cholecystectomy. Conclusion: In unusually extensive and severe cases of EPN, medical and minimally invasive procedures are not enough to control the infection. More aggressive management, including emergency surgery, should be implemented in selected patients who present with refractory septic shock associated with extensive disease.
RESUMO
Emphysematous pyelonephritis is a necrotizing renal infection that results in the presence of gas in renal parenchyma, collecting system, and surrounding tissues. Ninety-five percent of the patients have underlying uncontrolled diabetes mellitus, but non-diabetic patients may be affected due to ureteral obstruction and infection with gas forming pathogens. Several poor prognostic factors have been described, such as thrombocytopenia, acute kidney failure, impaired consciousness, and shock. We present a case of a 41-year-old female who attends to the emergency department with signs of septic shock and diffuse abdominal pain. The diagnosis of emphysematous pyelonephritis in a horseshoe kidney was confirmed.
