Conservative management of severe bilateral emphysematous pyelonephritis: Case series and review of literature
A 52-year-old lady with 14 years T2DM presented to emergency with fever, nausea, vomiting, decreased urine output, and left flank pain and swelling for 2 weeks. Examination was significant for anasarca, hypotension, and palpable swelling in the left lumbar region. X-ray abdomen was suggestive of EPN of left kidney []. CT abdomen revealed enlarged left kidney with irregular margins, presence of gas, and necrotic tissue which extended into the paranephric areas. Few foci of gas in the collecting system of right kidney were noted []. Fluid resuscitation, ionotropic support, and piperacillin-tazobactam plus linezoid were administered. Investigations [] revealed pyuria, culture from which revealed Klebsiella. She received two sittings of hemodialysis on day-2 and 7. PCD with drain in situ of left kidney was done on day-2 leading to drainage of 200 ml of pus, culture from which revealed E. coli. Both the organisms were sensitive to piperacillin and aminoglycosides. Amikacin was added on day-12 once renal function improved (creatinine: 1.2 mg/dl). The drain was subsequently removed after 8 weeks and patient discharged a week later.