- Email: [email protected]
Emphysematous Pyelonephritis in a Child with Nephrolithiasis
Emphysematous Pyelonephritis in a Child with Nephrolithiasis
A
4-year-old Caucasian female presented with abdominal pain, emesis, and fever. She had been having recurrent urinary tract infections over the past year prior to admission. She has had multiple urine cultures positive for Escherichia coli. Three days prior to admission, a renal ultrasound was performed and multiple renal stones were detected. A computed tomography of the abdomen and pelvis was performed on admission and showed multiple
renal calculi with the largest measuring 11 13 mm. In addition there was gas noted within the right renal collecting system (Figures 1 and 2; Figure 2 available at www.jpeds. com). She was started on intravenous meropenem, and a cystoscopy was performed with placement of a right ureteral stent. During her hospitalization, her urine cultures grew extended spectrum beta lactamase producing Escherichia coli, and we treated the patient with 7 days of intravenous meropenem. During the hospitalization, the patient’s clinical status improved significantly, her fever resolved, and her pain resolved. Emphysematous pyelonephritis is a rare clinical condition in a common disease that has been reported to occur almost exclusively in adult patients.1 It is associated with common pathogens and mostly described in patients with underlying systemic and urologic diseases2 but, as described in our case, can occur as well in healthy individuals. Emphysematous pyelonephritis has been primarily described as a mostly life-threatening and fulminant event. The outcome of our patient was excellent. n
Isabel T. Gross, MD, PhD University of South Florida Tampa, Florida
Ronald Ford, MD Joe DiMaggio Children’s Hospital Hollywood, Florida
References Figure 1. Coronal view of computed tomography of abdomen and pelvis with multiple renal calculi and gas within the right renal collecting system.
J Pediatr 2016;168:250. 0022-3476/$ - see front matter. Copyright ª 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2015.09.056
250
1. Michaeli J, Mogle P, Perlberg S, Hemiman S, Caine M. Emphysematous pyelonephritis. J Urol 1984;131:203-8. 2. Pontin AR, Barnes RD, Joffe J, Kahn D. Emphysematous pyelonephritis in diabetic patients. Br J Urol 1995;75:71-4.
Volume 168 January 2016
Figure 2. Axial view of computed tomography of abdomen and pelvis with multiple renal calculi and gas within the right renal collecting system.
250.e1
A
4-year-old Caucasian female presented with abdominal pain, emesis, and fever. She had been having recurrent urinary tract infections over the past year prior to admission. She has had multiple urine cultures positive for Escherichia coli. Three days prior to admission, a renal ultrasound was performed and multiple renal stones were detected. A computed tomography of the abdomen and pelvis was performed on admission and showed multiple
renal calculi with the largest measuring 11 13 mm. In addition there was gas noted within the right renal collecting system (Figures 1 and 2; Figure 2 available at www.jpeds. com). She was started on intravenous meropenem, and a cystoscopy was performed with placement of a right ureteral stent. During her hospitalization, her urine cultures grew extended spectrum beta lactamase producing Escherichia coli, and we treated the patient with 7 days of intravenous meropenem. During the hospitalization, the patient’s clinical status improved significantly, her fever resolved, and her pain resolved. Emphysematous pyelonephritis is a rare clinical condition in a common disease that has been reported to occur almost exclusively in adult patients.1 It is associated with common pathogens and mostly described in patients with underlying systemic and urologic diseases2 but, as described in our case, can occur as well in healthy individuals. Emphysematous pyelonephritis has been primarily described as a mostly life-threatening and fulminant event. The outcome of our patient was excellent. n
Isabel T. Gross, MD, PhD University of South Florida Tampa, Florida
Ronald Ford, MD Joe DiMaggio Children’s Hospital Hollywood, Florida
References Figure 1. Coronal view of computed tomography of abdomen and pelvis with multiple renal calculi and gas within the right renal collecting system.
J Pediatr 2016;168:250. 0022-3476/$ - see front matter. Copyright ª 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2015.09.056
250
1. Michaeli J, Mogle P, Perlberg S, Hemiman S, Caine M. Emphysematous pyelonephritis. J Urol 1984;131:203-8. 2. Pontin AR, Barnes RD, Joffe J, Kahn D. Emphysematous pyelonephritis in diabetic patients. Br J Urol 1995;75:71-4.
Volume 168 January 2016
Figure 2. Axial view of computed tomography of abdomen and pelvis with multiple renal calculi and gas within the right renal collecting system.
250.e1