A Case Report on Emphysematous Pyelonephritis in Patient on SGLT2 Inhibitor Therapy

Abstract

Emphysematous pyelonephritis, or EPN, is a life-threatening necrotizing infection that affects the renal parenchyma and, in certain cases, the perirenal tissue of the kidney. This condition most commonly results in gas formation within the renal parenchyma, the collecting system, or the perinephric tissue. Patients with diabetes mellitus are particularly susceptible to emphysematous pyelonephritis with a reported mortality rate of 40% to 90%. Clinical presentation of the disease is almost identical to acute pyelonephritis and requires precise assessment using imaging, particularly computed tomography (CT). This case report covers the clinical presentation of EPN in a patient in his 70s and is on SGLT2 inhibitor therapy. The causative organism here is Pseudomonas aeruginosa, a gram-negative bacterium which is a common pathogen that causes systemic infections affecting organs. This also brings to light the importance of an organized healthcare team's approach in adopting multidisciplinary management for better patient outcomes, including aggressive surgery options and less aggressive options like percutaneous drainage and antimicrobial therapy. The patient has recovered from the infection after a surgery and antimicrobial therapy for an almost 1 month.