Pielonefritis enfisematosa: Comunicación de un caso

OBJECTIVE: To describe an unusual case ofemphysematous pyelonephritis, a disease with high morbidi-ty and mortality.METHODS: We present the case of a 62-year old diabe-tic female with history of kidney stones, who consulted forfever, left lower-back pain and impairment of the generalcondition. Abdominopelvic computed tomography revealeda perinephric collection of air reaching the abdominal wall.RESULTS: After initial medical management with antibioticsand general supportive measures, we performed an openincision and drainage. A week later, signs of sepsis reap-peared and the left kidney was excised. The patient diedtwo weeks later of septic shock.CONCLUSIONS: This disease must be suspected in dia-betic females with renal lithiasis and pyelonephritis not res-ponding to treatment, and impaired general condition. Earlydiagnosis (computed tomography is the gold-standard) andsupportive measures are essential for initial management.Surgery can be open (drainage, initial or deferred nephrec-tomy), percutaneous (nephrostomy) or endoscopic (double-Jstent). Conservative management is a choice in bilateral ormild cases. Mortality rate is high and worsens with delayedtherapy