Severe Emphysematous Pyelonephritis in a Patient With Diabetes Mellitus

A 64-year-old lady presented with uncontrolled diabetes, septic shock and acute kidney injury. Non-contrast computed tomography scan of the abdomen showed complete replacement of the left kidney with air [Figure 1]. Ultrasound-guided needle aspiration was performed, which showed the presence of air in the parenchymal region. Her blood and urine cultures were sent. Patient was managed with inotropes, IV hydration, broad-spectrum antibiotics and sugar control. Two sessions of hemodialysis were performed. After stabilization, she was taken up for laparoscopic nephrectomy. Most of the renal area was replaced by air, residual tissue was removed, and a drain was put in situ. The patient improved gradually over the next few days.

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Figure 1: Computed tomography image showing left kidney replaced by large pocket of air density (-1000 HU) contained within renal capsule with few irregular soft tissue densities, likely residual kidney parenchyma (red arrow). Multiple small air pockets in perinephric space in left kidney (emphysematous pyelonephritis grade IIIa).

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