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Emphysematous pyelonephritis (EPN) is a rare but severe necrotizing infection often associated with diabetes, ureteral obstruction, and gas production in the renal parenchyma and perinephric area. This report describes a 54-year-old man with type 2 diabetes who presented with right lumbar pain and was diagnosed with EPN complicated by right ureteral calculi and perinephric gas accumulation. Despite initial improvement with fluid resuscitation, antibiotics, and drainage, inadequate blood glucose control led to a worsening of the infection, eventually involving the psoas major muscle and iliac vessels.

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Unraveling the uncommon: Pneumoperitoneum induced by emphysematous pyelonephritis.

Radiol Case Rep

March 2025

Emergency Radiology Department, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco.

Emphysematous pyelonephritis is a necrotizing infection of the renal parenchyma by gas-forming organisms, with a risk of the gas extending into peri-nephric or para-renal spaces and in advanced cases, the involvement may be extensive and bilateral. It is a common complication in patients with long-term diabetes, primarily caused by Gram-negative organisms or, in some cases, anaerobes. The diagnosis of emphysematous pyelonephritis is made by clinical features and confirmed by computed tomography.

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Fournier's gangrene is a grave necrotizing fasciitis that primarily affects the perineum, spreading through the fascias and leading to significant tissue destruction. The involvement of the urethra in necrosis is extremely rare, if not anecdotal. Emphysematous pyelonephritis, is a urinary infection with a high risk of progression to sepsis.

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BACKGROUND Emphysematous urinary tract infections are rare and serious conditions that are often multifactorial in etiology and may be associated with the presence of renal stones. Diagnosis can be made by finding gas within the renal collecting system or parenchyma. However, the radiographic finding of gas within a renal stone is rare and little has been published to describe the significance of this finding, its promoting factors, and management.

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Article Synopsis
  • Emphysematous pyelonephritis (EPN) is a severe urinary tract infection that can lead to high mortality rates, particularly in cases with underlying conditions, but it's rarely reported.
  • A 32-year-old pregnant woman with type 2 diabetes experienced worsening symptoms of pyelonephritis, leading to a diagnosis of EPN through imaging techniques.
  • Successful treatment involved antibiotic therapy, emphasizing the importance of early diagnosis and customized treatment approaches to safeguard both maternal and fetal health during pregnancy.
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