Emphysematous pyelonephritis with extensive gas accumulations in a patient with poorly controlled diabetes: A case report

RATIONALE: Emphysematous pyelonephritis (EPN) is a rare but severe necrotic renal parenchymal infection with gas accumulation in the renal or extrarenal spaces. Patient could present as sepsis with a high mortality. Prompt diagnosis and treatments are essential to save the lives of affected patients. PATIENT CONCERNS: Here, we report a 64-year-old woman with poorly controlled diabetes. She presented with fever, progressive right flank pain, dysuria, urinary frequency, and urgency. DIAGNOSES: A computed tomography scan showed right renal parenchymal necrosis with extensive perinephric gas accumulation that extended inferiorly to the right ureter, bladder, and right iliac fossa, posteriorly to the bilateral psoas and erector spinae muscles, and superiorly to the perihepatic space, mediastinum, left shoulder, and left side of the neck. The massive extent of the gas accumulation was rarely reported previously. EPN was diagnosed. INTERVENTIONS: She received intravenous antibiotics, blood glucose control and percutaneous drainage. OUTCOMES: She successfully recovered after a series of treatments. LESSONS: Early identification and initiation of etiological treatment, as well as symptomatic treatment for EPN are crucial for saving patients' lives.