Conservative management of severe bilateral emphysematous pyelonephritis: Case series and review of literature
A 38-year-old lady with 10 years type 2 diabetes mellitus (T2DM) presented with pain abdomen, fever, nausea, and vomiting for 2 weeks and decreased urine output for 2 days. Investigations revealed pyuria, renal failure, and leukocytosis []. Piperacillin-tazobactam plus linezoid was started empirically. Computerized tomography (CT) abdomen following initially suggestive ultrasonography (USG) revealed severe bilateral EPN (left > right) [] with gas in bilateral renal parenchyma extending into left perinephric and paranephric areas. Urine culture was positive for Klebsiella sensitive to piperacillin. She became afebrile after 3 days. General well-being improved with increase in urine output, reduction in serum urea, and creatinine. Repeat USG done weekly showed improvement in EPN. She was discharged after 5 weeks. Last evaluated, she was doing well 8 months after diagnosis.