Emphysematous pyelitis: a case report

Document Type : Case Report


1 Nursing Student, Research Committee, Golestan University of Medical Sciences, Golestan, Iran

2 Associate Professor, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran

3 Nurse, Golestan University of Medical Sciences, Gorgan, Iran

4 Radiologist, Golestan University of Medical Sciences, Gorgan, Iran

5 Assistant Professor of Epidemiology, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran

6 Professor, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran


Background: Emphysematous pyelitis is a rare disease, and there is limited scientific literature documenting the same. Despite being a relatively benign condition, this disease is often unreported. In light of this, the purpose of this study is to present a rare case of emphysematous pyelitis, contributing vital information on this disease.
Case presentation: A 51-year-old female patient hailing from northern Iran presented at the hospital with symptoms of fever, chills, lethargy, and side pain. Her medical history revealed that she suffered from kidney stones, thyroid disease, grade 1 fatty liver disease, anemia, and cardiovascular disease. The patient was diagnosed with emphysematous pyelitis using computed tomography (CT) scanning and was promptly treated with antibiotics. Subsequently, the patient's condition improved considerably, and abscess drainage was recommended. After symptoms abated, the patient was discharged from the hospital, receiving Litorex B for removing the stones. Surgery for the removal of the stones was not pursued immediately, given that the patient's kidneys were continuing to produce urine.
Conclusion: The patient in this case report was diagnosed with emphysematous pyelitis using a CT scan and treated with antibiotics, while abscess drainage was suggested. Reporting uncommon cases such as this can significantly increase medical students' awareness of such diseases, leading to prompt diagnosis and appropriate treatment. Additionally, further research in the field of emphysematous pyelitis can reduce the incidence and mitigate the complications arising from this rare condition.


Main Subjects

  1. Hiremath R, Padala KP, Swamy K, Pailoor A. A rare case of pneumoureter: emphysematous pyelitis versus emphysematous pyelonephritis. J Clin Diagn Res. 2015;9(11):TD03. doi:10.7860/JCDR/2015/13949.6824 PMid:26676155 PMCid:PMC4668507
  2. McCafferty G, Shorette A, Singh S, Budhram G. Emphysematous pyelonephritis: bedside ultrasound diagnosis in the emergency department. Clin Pract Cases Emerg Med. 2017;1(2):92. doi:10.5811/cpcem.2016.12.32714 PMid:29849419 PMCid:PMC5965426
  3. Ubee SS, McGlynn L, Fordham M. Emphysematous pyelonephritis. BJU Int. 2011;107(9):1474-8. doi:10.1111/j.1464-410X.2010.09660.x PMid:20840327
  4. Kua CH, Aziz YA. Air in the kidney: between emphysematous pyelitis and pyelonephritis. Biomed Imaging Interv J. 2008;4(4). doi:10.2349/biij.4.4.e24 PMid:21611013 PMCid:PMC3097740
  5. Vasudevan R. Urinary tract infection: an overview of the infection and the associated risk factors. J Microbiol Exp. 2014;1(2):00008. doi:10.15406/jmen.2014.01.00008
  6. Grayson DE, Abbott RM, Levy AD, Sherman PM. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics. 2002;22(3):543-61. doi:10.1148/radiographics.22.3.g02ma06543 PMid:12006686
  7. Chiang CC, Jong YS, Wang WJ. Emphysematous pyelitis. Can Med Assoc J. 2010;182(7):698. doi:10.1503/cmaj.091055 PMid:20231336 PMCid:PMC2855919
  8. Roy C, Pfleger DD, Tuchmann CM, Lang HH, Saussine CC, Jacqmin D. Emphysematous pyelitis: findings in five patients. Radiology. 2001;218(3):647-50 doi:10.1148/radiology.218.3.r01fe14647 PMid:11230634
  9. Derouiche A, El Attat R, Hentati H, Blah M, Slama A, Chebil M. Emphysematous pyelitis: epidemiological, therapeutic and evolutive features. Tunis Med. 2009;87(3):180-3.
  10. Mazumder P, Al-Khouja F, Moeller J, Lahham S. A Case Report on Distinguishing Emphysematous Pyelitis and Pyelonephritis on Point-of-care Ultrasound. Clin Pract Cases Emerg Med. 2021;5 (1):35. doi:10.5811/cpcem.2020.11.49892 PMid:33560948 PMCid:PMC7872620
  11. Tsitouridis I, Michaelides M, Sidiropoulos D, Arvanity M. Renal emphysema in diabetic patients: CT evaluation. Diagn Interv Radiol. 2010;16(3):221.
  12. Nepal P, Ojili V, Kaur N, Tirumani SH, Nagar A. Gas where it shouldn't be! imaging spectrum of emphysematous infections in the abdomen and pelvis. Am J Roentgenol. 2021;216(3):812-23. doi:10.2214/AJR.20.23545 PMid:33439049
  13. Evanoff GV, Thompson CS, Foley R, Weinman EJ. Spectrum of gas within the kidney: emphysematous pyelonephritis and emphysematous pyelitis. Am J Med. 1987; 83(1):149-54. doi:10.1016/0002-9343(87)90511-0 PMid:3300321