Management of emphysematous pyelonephritis with antibiotic therapy and colocation of double J catheter A case report

Abstract

Introduction: Emphysematous pyelonephritis is not a common infection, but it has a high mortality rate. Empirical antibiotic treatment is the first line of treatment; however, placing a double J catheter can be a viable resource for draining pus and gas in the renal parenchyma.

Case report: 51-year-old type 2 diabetic woman. She was admitted for seven days of dysuria, fever of 39°C, and capillary blood glucose 450 mg/dl. With arterial hypotension (85/50 mmHg), tachycardia and hypoxemia.

Diagnostic workshop: The studies reported azotemia, decompensated metabolic acidosis, leukocytosis of 47,400 u/ul, neutrophils 85%, platelets 30,000 u/ul, and Hb 9 gr/dl. In a computed tomography of the abdomen, emphysema is observed that dilates the left renal pelvis, with gas that spreads through the ureter to the bladder.

Evolution: The patient was transferred to intensive care due to hemodynamic instability, renal failure, tachyarrhythmia, and resistant metabolic acidosis with the need for hemodialysis. A double J catheter was placed, and 380 ml of purulent urine was drained, which was cultured with Klebsiella Pneumoniae sensitive to ceftazidime + avibactam. After the intervention, there was a progressive improvement.

Conclusions: We report a clinical-surgical case that allowed us to expand the vision of managing emphysematous pyelonephritis. The use of the double J device in the initial management, plus antibiotic therapy, allowed the patient to recover from septic shock.