exudates and Emphysema

We present an interesting and rare case of a diabetic patient who developed extensive unilateral emphysematous pyelonephritis (EPN) which was caused by fungal infection. The diagnosis was confirmed on computed tomography (CT) scan of the abdomen. Repeated urine cultures grew Candida albicans but no other organisms were isolated. The patient remained febrile and unwell despite parenteral broad spectrum antibiotics and antifungal treatment. She underwent nephrectomy and then made a good clinical recovery.

Topics: Adult; Anti-Bacterial Agents; Antifungal Agents; Candida albicans; Candidiasis; Diabetes Mellitus, Type 2; Emphysema; Female; Fluconazole; Humans; Insulin; Malaysia; Nephrectomy; Pyelonephritis; Risk Factors; Treatment Outcome

It is known that alpha1-antitrypsin deficiency is associated with emphysema in adults and liver cirrhosis in neonates. The phenotypes PiZZ and PiSZ are considered to be high risk groups. alpha1-antitrypsin deficiency is one of the most common lethal congenital disorders in Europe and the USA, occurring in approximately 1 in 2,000 caucasians of North European descent. Studies in Malaysia have found that the phenotypes PiZ and PiS are present in our population. Out of 950 samples analyzed, it was found that 10 samples were shown to be apparently Z homozygous phenotype. The phenotype is determined by high resolution isoelectrofocusing on an ultra-thin polyacrylamide gel embedded with narrow range Pi phamarlyte. The isoelectrofocused bands are confirmed by immunofixation and the plasma alpha1-antitrypsin levels determined by electroimmunoassay. The abnormal phenotypes are further confirmed by polymerase chain reaction using allele specific oligonucleotides.

Topics: Adult; Aged; alpha 1-Antitrypsin; alpha 1-Antitrypsin Deficiency; Child, Preschool; Emphysema; Europe; Genes, Lethal; Genetic Variation; Genotype; Humans; Infant; Infant, Newborn; Jaundice; Liver Cirrhosis; Malaysia; Middle Aged; Polymerase Chain Reaction; United States

Topics: alpha 1-Antitrypsin Deficiency; Emphysema; Humans; Malaysia; Middle Aged

Topics: Adult; Aged; Emphysema; Female; Humans; Malaysia; Male; Middle Aged; Respiratory Function Tests