ro13-9904 and Emphysema

Bilateral emphysematous pyelonephritis is a life threatening condition usually occurring in diabetics. Management of this condition has traditionally been aggressive and surgery is considered mandatory. However, this is itself a hazardous intervention in a septic, unstable patient with circulatory or liver failure. When bilateral disease is present, the need for long-term dialysis is obviously unavoidable.. We herein report one of the few cases of bilateral emphysematous pyelonephritis successfully managed by non-surgical treatment.

Topics: Adult; Amikacin; Cardiotonic Agents; Ceftriaxone; Diabetes Mellitus, Type 2; Dopamine; Emphysema; Female; Fluid Therapy; Humans; Hypoglycemic Agents; Insulin; Pyelonephritis; Radiography; Treatment Outcome

Topics: Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortitis; Ceftriaxone; Diagnosis, Differential; Emphysema; Humans; Male; Middle Aged; Salmonella Infections; Tomography, X-Ray Computed

Topics: Abdomen; Anti-Bacterial Agents; Ceftriaxone; Emphysema; Humans; Male; Middle Aged; Pelvis; Pneumorrhachis; Pyelonephritis; Tomography Scanners, X-Ray Computed

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Emphysema; Escherichia coli; Escherichia coli Infections; Female; Humans; Kidney; Nephrectomy; Pyelitis; Tomography, X-Ray Computed

A 54-year-old male with long-standing diabetes presented with vague left flank pain for 5 days with uncontrolled blood glucose. The patient was commenced on insulin and injectable ceftriaxone empirically, for possibly acute pyelonephritis. Ultrasound examination revealed extensive emphysematous pyelonephritis of upper half of left kidney with involvement of perinephric space. Computed tomography of abdomen confirmed the diagnosis of emphysematous pyelonephritis which was categorised as class IIIa. The recommended treatment for class IIIa emphysematous pyelonephritis is nephrectomy but the patient refused to give consent for surgery or even percutaneous drainage. Thus, the patient was continued on medical management alone and surprisingly showed marked recovery over the next few days. There were no new complications, and the patient was discharged after 2 weeks of antibiotics with 2 more weeks of oral antibiotics. After 4 months, the ultrasound showed normal kidneys. We present this case because it adds to the little existing evidence that conservative management can successfully cure patients with class IIIa emphysematous pyelonephritis, although supplementation with percutaneous drainage would have been better in this case.

Topics: Anti-Bacterial Agents; Ceftriaxone; Diabetic Nephropathies; Emphysema; Humans; Hypoglycemic Agents; Insulin; Kidney; Male; Middle Aged; Pyelonephritis; Treatment Outcome; Ultrasonography

Topics: Abdominal Pain; Ceftriaxone; Cystitis; Cystoscopy; Diagnosis, Differential; Emphysema; Female; Humans; Middle Aged; Tomography, X-Ray Computed; Urinary Bladder; Urinary Catheterization

Topics: Abdominal Abscess; Abdominal Pain; Aged; Anti-Bacterial Agents; Ceftriaxone; Combined Modality Therapy; Drainage; Emphysema; Female; Flank Pain; Gases; Humans; Klebsiella Infections; Pyelonephritis; Radiography, Abdominal; Rupture, Spontaneous; Tomography, X-Ray Computed

Topics: Anti-Bacterial Agents; Ceftriaxone; Diabetic Nephropathies; Emphysema; Escherichia coli; Escherichia coli Infections; Female; Flank Pain; Humans; Middle Aged; Nephrostomy, Percutaneous; Oliguria; Pyelitis

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Emphysema; Humans; Hypoglycemic Agents; Insulin; Pancreatitis, Acute Necrotizing

Topics: Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Cystitis; Emphysema; Female; Humans; Incidental Findings; Kidney Failure, Chronic; Klebsiella pneumoniae; Middle Aged; Renal Dialysis; Tomography, X-Ray Computed; Treatment Outcome; Urinary Bladder; Urine

Emphysematous pyelonephritis is characterized by infection and gas formation in the renal parenchyma. This rare disorder tends to occur more frequently in patients with diabetes mellitus and urinary tract obstruction. In this case report, we describe a nondiabetic patient with Hinman syndrome who developed recurrent emphysematous pyelonephritis that was successfully treated with antibiotics on both occasions.

Topics: Anti-Bacterial Agents; Ceftriaxone; Emphysema; Escherichia coli Infections; Humans; Male; Middle Aged; Pyelonephritis; Recurrence; Remission Induction

Topics: Aged; Anti-Bacterial Agents; Arthritis, Rheumatoid; Bacteremia; Bronchopneumonia; Ceftriaxone; Debridement; Dermatitis, Perioral; Diagnosis, Differential; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Emphysema; Fasciitis, Necrotizing; Fatal Outcome; Female; Heart Failure; Humans; Metronidazole; Respiration, Artificial; Streptococcus agalactiae; Vancomycin

Topics: Aged; Ceftriaxone; Drainage; Emphysema; Female; Humans; Middle Aged; Nephrectomy; Pyelonephritis