Emphysematous Pyelonephritis Treated with Vacuum Sealing Drainage

Emphysematous pyelonephritis (EPN) is a rare infectious disease, of which risk factors are poorly controlled diabetes mellitus, immunosuppression, and urinary tract obstruction. In comparison with simple pyelonephritis, EPN is an acute severe necrotizing and gas‑forming infection of the renal parenchyma with a mortality rate of up to 25%. Among the reported cases of EPN, there has only been one report of the disease where the " invisible kidney " was detected in the lung windows on noncontrast abdominal computed tomography (CT). This rare case was treated with vacuum sealing drainage (VSD, Weigao Holding, China) and recovered quickly. We reported an unusual case of a patient who suffered from EPN. A 46‑year‑old woman presented to the emergency department with complaints of a one week history of fever, chills, and right flank pain. No urinary symptoms were reported. The patient had diabetes mellitus with poor glucose control. She had no other previous significant medical history. The patient was in poor general condition. On examination, the following was recorded: pulse 1 2 0 b e a t s / m i n , b l o o d p r e s s u r e 9 0 / 6 0 m m H g (1 mmHg = 0.133 kPa), temperature 39.5°C, respiration 18 breaths/min. The patient appeared in distress, and her abdomen was mildly distended. There was marked tenderness in right lumbar and hypochondriac area. Rest of the examination was normal. Blood investigations revealed hemoglobin (Hb) of 115 g/L, total white cell count 29.41 × 10 9 /L, platelet count 520 × 10 9 /L, red blood cells (RBC) 4.12 × 10 12 /L. Urine analysis showed ketone 4+, glucose 4+, albumin 2+, hematuria 2+, proteinuria 2+, and pus cells 80/hpf. Blood urea was 15.6 mmol/L and serum creatinine (Scr) 140 µmol/L. Random blood glucose was 28.9 mmol/L. Arterial blood gas analysis showed mild metabolic acidosis. Compensated metabolic acidosis (pH 7.285, pCO 2 9.7 mmHg, PO 2 88.8 mmHg, HCO 3 4.7 mmol/L, and base excess –18.1 mmol/L). Total serum bilirubin was 4.4 µmol/L (direct 2.3 µmol/L). Hepatic transaminases were normal. Serum proteins were 70.9 g/L with an albumin of 33.6 g/L. Serum sodium, potassium, calcium, phosphorous, and uric acid estimations were normal. Human immunodeficiency virus (HIV) and hepatitis B surface antigen (HBsAg) tests were negative. Electrocardiogram and chest X‑ray did not reveal any abnormality. Ultrasound showed intense reflections with dirty acoustic …