A Case Report of Incidental Diagnosis of Emphysematous Pyelonephritis in an 88-Year-Old Man Without Any Previous Medical History

Emphysematous pyelonephritis is one of the acute pyogenic kidney infections that can be life-threatening. This disease is essentially a gas-forming infection that affects the parenchyma and surrounding tissues of the kidney. The patient we introduced in this study is an 88-year-old man who presented to the emergency department with decreased levels of consciousness. This patient had no previous medical history and no risk factors for developing emphysematous pyelonephritis. Laboratory tests showed moderate leukocytosis and a creatinine level of 9.8 mg/dL. Urinalysis reported a high number of white blood cells, red blood cells, and bacteria. The urinary culture was positive for E. coli. Subsequently, an abdominal and pelvic ultrasound was performed, which showed slightly increased echogenicity of the renal cortical parenchyma and minimal urinary stasis in the right kidney, along with the presence of gas in some areas. To confirm the diagnosis of emphysematous pyelonephritis, the patient underwent a CT scan of the abdomen and pelvis, which revealed gas in the renal parenchyma and perirenal space. Initially, the patient received hydration and antibiotic treatment and underwent dialysis once due to high uremia. After stabilizing the patient’s condition, he underwent drainage and nephrostomy. Many studies recommend medical management over surgical interventions as the first approach in dealing with such patients, as it tends to be more effective and efficient.