Case Report: Emphysematous Pyelonephritis Triggers Diabetic Ketoacidosis in a 60 Years Old Patient

The report describes the case of a 60 years old female patient admitted in our emergency department with main complaints of abdominal pain, malaise, fever and oliguria the last three days. The primary blood samples investigations revealed leukocytosis, acute renal function impairment and increased serum glucose. The patient is known with diabetes type II for the last fifteen years, has been in treatment with metformin and basic insulin therapy but the disease remains not well controlled. Further laboratory investigation and physical examination were consistent with the diagnosis of diabetic ketoacidosis. The urine examination showed pyuria leading to the diagnosis of a urinary tract infection. The abdominal XRAY was without abnormal findings but in the ultrasound and abdominal CT, a few renal parenchymatic lesions have been observed, more clearly seen on the CT. The presence of air within the tissue was consistent with a very rare and life-threatening infection, known as emphysematous pyelonephritis. The patient was put on the necessary treatment.