Keywords
Emphysematosus Pyelonephritis
Imaging
How to Cite
Abstract
Background. Emphysematous osteomyelitis and emphysematous pyelonephritis are both rare entities responsible for a high death rate. The first is defined by the presence of intravertebral or intraosseous gas, while the second is infectious damage to the renal parenchyma and perilesional tissues caused by gas-producing microorganisms and is, therefore, characterized by the formation of gas. Imaging plays a crucial role in making a rapid diagnosis and, thus, the initiation of the necessary treatment.
Case Report. A 66-year-old woman with a medical history of type 2 diabetes mellitus and hypertension presented with the altered general condition and flank pain for 5 days, associated with fever and chills. The patient’s vital signs were remarkable with a disturbed biological workup, which led to emergency abdominal and pelvic computed tomography scanning that revealed emphysematous osteomyelitis of the spine and emphysematous pyelonephritis.
Conclusions. The coexistence of emphysematous pyelonephritis and emphysematous osteomyelitis is a rare life-threatening entity, occurring in patients with comorbidities such as diabetes mellitus. Computed tomography is currently the gold standard in making the positive diagnosis, staging, for a quick and better management and, thus, a favorable prognosis.
References
Koch GE, Johnsen NV. The diagnosis and management of life-threatening urologic infections. Urology. 2021;156:6–15. Available from: https://doi.org/10.1016/j.urology.2021.05.011
Kamei J, Yamamoto S. Complicated urinary tract infections with diabetes mellitus. Journal of Infection and Chemotherapy. 2021;27(8):1131–1136. Available from: https://doi.org/10.1016/j.jiac.2021.05.012
Sax AJ, Morrison WB, Belair JA. Extensive multifocal emphysematous osteomyelitis: fatal outcome in a patient with psychiatric history. Skeletal Radiology. 2020;49(9):1487–1493. Available from: https://doi.org/10.1007/s00256-020-03470-4
Sulyma V, Sribniak A, Bihun R, Sribniak Z. Emphysematous osteomyelitis: review of the literature. Ortopedia, Traumatologia, Rehabilitacja. 2020;22(3):153-159. Available from: https://doi.org/10.5604/01.3001.0014.3231
Tatakis F-P, Kyriazis I, Panagiotopoulou I-E, Kalafatis E, Mantzikopoulos G, Polyzos K, et al. Simultaneous diagnosis of emphysematous osteomyelitis and emphysematous pyelonephritis in a diabetic patient. American Journal of Case Reports. 2019;20:1793–1796. Available from: https://doi.org/10.12659/AJCR.920006
Small JE, Chea P, Shah N, Small KM. Diagnostic features of emphysematous osteomyelitis. Current Problems in Diagnostic Radiology. 2018. Available from: https://doi.org/10.1067/j.cpradiol.2018.05.008
Lee J, Jeong CH, Lee MH, Jeong E-G, Kim YJ, Kim SI, et al. Emphysematous osteomyelitis due to Escherichia coli. Infection & Chemotherapy. 2017;49(2):151-154. Available from: https://doi.org/10.3947/ic.2017.49.2.151
Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. RadioGraphics. 2008;28(1):255–276. Available from: https://doi.org/10.1148/rg.281075171
Tang HJ, Li CM, Yen MY, Chen YS, Wann SR, Lin HH, Lee SS, Liu YC. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. 2001;34(2):125-130. Available from: https://pubmed.ncbi.nlm.nih.gov/11456358/
Mujer MT, Rai MP, Hassanein M, Mitra S. Emphysematous osteomyelitis. BMJ Case Rep. 2018;2018:bcr2018225144. Available from: https://doi.org/10.1136/bcr-2018-225144
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