Bilateral Emphysematous Pyelonephritis in a Retroviral Disease Patient.

Abstract

Introduction: Emphysematous pyelonephritis is a rare infection characterized by presence of gas in the renal parenchyma and surrounding tissues. It is commonly found in diabetics and rarely in HIV patients. Case report: A 41 year old retroviral positive female patient on HAART with a four year history of recurrent bilateral flank pains.There was also a history of haematuria, pneumaturia, low grade fever and vomiting. Physical examination was not remarkable. Urinalysis showed blood +++ and protein +, urine m/c/s yielded a growth of Klebsiella spp., biochemical profile revealed elevated urea andcreatinine, Abdomino-pelvic contrast enhanced CT showed multiple air collections in the renal parenchyma and collecting systems of both kidneys with bilateral hydronephrosis as well as hyperdense filling defect within the gallbladder.She was managed on oral Levofloxacin on outpatient basis. Conclusion: Emphysematous pyelonephritis though rare in HIV patients without other risk factors can however occur. The treatment of choice for bilateral emphysematous pyelonephritis is percutaneous catheter drainage of air/abscess, however, in select cases as in our patient, they can be managed on outpatient basis with oral antibiotics.