Massive bilateral grade IV emphysematous pyelonephritis: Case report
Carlos Adrián Pérez Martínez,
Ixchel Guadalupe Rodríguez Barajas,
Maria Fernanda Carballar Jeréz,
Brenda Lara González,
Luis Jonathan Ramírez Porras,
Luis Alberto García Fierro,
Edmundo Rivero Sánchez
Affiliations
Carlos Adrián Pérez Martínez
Department of Internal Medicine, Regional General Hospital Num. 72 “Lic. Vicente Santos Guajardo”, Mexican Social Security Institute, Tlalnepantla de Baz, State of Mexico, Mexico; Correspondence to: Av. Filiberto Gomez NN, Col industrial, ZIP 54000, Tlalnepantla de Baz, State of Mexico, Mexico.
Ixchel Guadalupe Rodríguez Barajas
Department of Internal Medicine, Regional General Hospital Num. 72 “Lic. Vicente Santos Guajardo”, Mexican Social Security Institute, Tlalnepantla de Baz, State of Mexico, Mexico
Maria Fernanda Carballar Jeréz
Department of Internal Medicine, Regional General Hospital Num. 72 “Lic. Vicente Santos Guajardo”, Mexican Social Security Institute, Tlalnepantla de Baz, State of Mexico, Mexico
Brenda Lara González
Department of Internal Medicine, Regional General Hospital Num. 72 “Lic. Vicente Santos Guajardo”, Mexican Social Security Institute, Tlalnepantla de Baz, State of Mexico, Mexico
Luis Jonathan Ramírez Porras
Department of General Surgery, High Specialty Regional Hospital ''Bicentenario de la independencia'', Institute for Social Security and Services for State Workers, Tultitlan de mariano escobedo, State of México, Mexico
Luis Alberto García Fierro
Department of Internal Medicine, General Hospital Ajusco Medio, Secretary of Health of Mexico City, Mexico City, Mexico
Edmundo Rivero Sánchez
Department of Internal Medicine, Regional General Hospital Num. 72 “Lic. Vicente Santos Guajardo”, Mexican Social Security Institute, Tlalnepantla de Baz, State of Mexico, Mexico
Emphysematous pyelonephritis (EPN) is a severe disease of the renal system in which gas formed by facultative anaerobe microorganisms accumulates, being Escherichia coli the most representative causative agent. A series of conditions foster its development including uncontrolled diabetes mellitus, diabetic nephropathy and obstructive uropathy. Abdominal CT scan continues to be the gold standard for diagnosis. Currently, nephrectomy is avoided as much as possible, and more conservative treatments are given. Mortality is still as high as 21 % despite new therapeutic options, all of which are mostly surgical. The rarest cases are those classified as grade IV, which affect both kidneys; these are considered the most lethal of the clinical presentations and they are also of particular interest, since a multidisciplinary team must be in charge of treatment. Herein, we present the case of an elderly woman with chronic diseases and a presentation of massive emphysematous pyelonephritis concurrent with emphysematous cystitis and pneumoperitoneum, who required bilateral radical nephrectomy despite efforts of preserving at least one of the kidneys.
