Conservative management of severe bilateral emphysematous pyelonephritis: Case series and review of literature
A 36-year-old lady with 8 years of poorly controlled T2DM and three episodes of urinary tract infection in last 18 months presented with high grade fever, vomiting, burning micturation, and prostration for 1 week. Investigations revealed pyuria, renal failure, and leukocytosis []. CT abdomen revealed bilateral EPN (left >> right) with extension of gas into bilateral perinephric and paranephric tissues []. Piperacillin-tazobactam plus linezoid was started, later changed to imipenem-cilastatin as per the culture (E. coli) and antibiogram report. PCD with drain in situ of left kidney was done on day-3 admission leading to drainage of 300 ml pus. She showed rapid clinical improvement. Improvement in EPN was documented by repeated USG. The drain was removed after 6 weeks and patient discharged a week later.