A case of emphysematous empyema and pneumomediastinum associated with emphysematous pyelonephritis

Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the accumulation of gas in the renal parenchyma and surrounding tissues. Although there have been a few cases of EPN accompanied by either pneumoperitoneum or pneumomediastinum, this case should be considered important due to the marked extent of the emphysematous empyema. The patient did not know of her diabetes until admission. Her HbA1c was 15.3% on admission. Her symptoms included dyspnea, fever, and left-side flank pain. Hypotension and tachycardia were strongly suggestive of sepsis. The simple x-ray and abdominal and chest computed tomography (CT) findings confirmed the diagnosis of EPN extending to the thoracic cavity. A combination of antibiotics and percutaneous drainage was performed. After several weeks, the patient underwent a nephrectomy. Despite these attempts, the patient died due to postoperative infection combined with hospital-acquired pneumonia.