Coexistence of Emphysematous Pyelonephritis and Cystitis Rarely Seen in an Uncontrolled Diabetes Mellitus Case:

Emphysematous pyelonephritis (EP) and emphysematous cystitis (EC) are rare urinary tract infections that are more frequently seen in women. Nearly 90% of the patients have diabetes mellitus (DM). In uncontrolled DM patients, factors that increase the frequency of infection consist of presence of high glucose in tissues, impaired tissue perfusion due to angiopathy and impaired immune response. They generally start suddenly and progress rapidly. They develop within a short time following septicemia and acute kidney failure symptoms. Due to the limited benefit of laboratory tests, growing of microorganisms in blood and urine cultures is of critical importance. The most sensitive radiological test for showing gas accumulation as well as identifying its localization and boundaries is abdominal computed tomography (CT). The current prevailing general opinion favors starting broad spectrum antibiotherapy without waiting for culture results and then performing percutaneous catheter drainage if necessary, depending on the clinical condition of the patient. Nephrectomy is performed in nonresponsive cases. Therefore, in urinary tract infections that are nonresponsive despite antibiotherapy in patients diagnosed with DM, EP or EC should be suspected primarily, and diagnosis and treatment should not be delayed