Kidney Res Clin Pract.  2014 Sep;33(3):150-153. 10.1016/j.krcp.2014.05.001.

Emphysematous pyelonephritis initially presenting as a spontaneous subcapsular hematoma in a diabetic patient

Affiliations
  • 1Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. cmckyo@catholic.ac.kr
  • 2Department of Radiology, The Catholic University of Korea, Seoul, Korea.

Abstract

Emphysematous pyelonephritis (EPN) is a life-threatening infection characterized by the formation of gas. Complications of EPN include septic shock, acute renal failure, and disseminated intravascular coagulation. Spontaneous subcapsular hematoma (SCH) has also been reported as a rare complication of EPN, although there have been no reports to date of this occurring prior to the presentation of EPN. We report a case of EPN that initially presented as spontaneous SCH. The patient was admitted for left flank pain, and initial computed tomography revealed SCH without any air shadows. Laboratory findings and clinical symptoms suggested the presence of urinary tract infection and the patient was started on antibiotics. Fever developed 24 hours after admission. On follow-up computed tomography 7 days later, EPN was newly observed, and a percutaneous drain was inserted. Blood, urine, and drainage fluid cultures all revealed growth of extended-spectrum beta-lactamase-negative Escherichia coli.

Keyword

Emphysema; Hematoma; Pyelonephritis

MeSH Terms

Acute Kidney Injury
Anti-Bacterial Agents
Disseminated Intravascular Coagulation
Drainage
Emphysema
Escherichia coli
Fever
Flank Pain
Follow-Up Studies
Hematoma*
Humans
Pyelonephritis*
Shock, Septic
Urinary Tract Infections
Anti-Bacterial Agents
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