Infect Chemother.  2013 Sep;45(3):331-334. 10.3947/ic.2013.45.3.331.

Emphysematous Pyelonephritis Caused by Citrobacter freundii in a Patient with Type 2 Diabetes and Neurogenic Bladder

• Kim MJ
• Park JS
• Lim HJ
• Jung J
• Shin DG
• Lee KD
• Jung YY
• Min KW
• Han KA

• KMID: 2170433
• DOI: http://doi.org/10.3947/ic.2013.45.3.331

Abstract

Emphysematous pyelonephritis (EPN) is a rare, life-threatening complication of upper urinary tract infections that is characterized by the presence of gas in the renal parenchyma and perirenal space. It commonly occurs in diabetic patients. Escherichia coli are the most common causative organisms, with few reports implicating Citrobacter freundii as the etiologic agent in EPN. A 57-year-old woman with diabetes and neurogenic bladder visited at our department with confused mentality, myalgia, and general weakness. Further investigation revealed that the patient suffered from unilateral EPN with sepsis caused by C. freundii. The patient's condition was improved considerably with percutaneous drainage and use of intravenous antibiotics for several weeks. However, renal function eventually deteriorated to permanent renal failure, which required hemodialysis. In conclusion, C. freundii may be the causative pathogen of EPN in a patient with type 2 diabetes and neurogenic bladder.

Keyword

Emphysematous pyelonephritis; Citrobacter freundii; Diabetes mellitus

MeSH Terms

Anti-Bacterial Agents
Citrobacter
Citrobacter freundii
Diabetes Mellitus
Drainage
Escherichia coli
Female
Humans
Middle Aged
Pyelonephritis
Renal Dialysis
Renal Insufficiency
Sepsis
Urinary Bladder, Neurogenic
Urinary Tract Infections
Anti-Bacterial Agents

Figure

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  Figure 1 Abdominal computed tomography images show an enlarged left kidney with heterogenous enhancement with perinephric infiltration and fluid. (A) Axial image shows a collection of gas bubbles in the left renal parenchyma (white arrowhead). (B) Enlarged image is shown.

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