Case ReportEmphysematous Pyelonephritis Presenting as GastroenteritisEL-Hennawy, Adel S MD, FACP1*; Kona, Hima MD2Author Information 1Director, Nephrology and Dialysis Center, Department of Medicine, Renal Division; and 2Pulmonary Fellow, Coney Island Hospital, Brooklyn, New York. *Address for correspondence: P.O. Box 61540, Staten Island, NY 10306. E-mail: [email protected] American Journal of Therapeutics: November 2007 - Volume 14 - Issue 6 - p 588-591 doi: 10.1097/MJT.0b013e3180ed8fd6 Buy Metrics Abstract Emphysematous pyelonephritis (EPN) is a serious and often life-threatening condition due to a gas-producing and necrotizing infection involving the renal parenchyma and perirenal tissue. The infection is almost exclusively seen in diabetic patients, and the main feature of its presence is finding gas within the kidney. Patients usually present with fever, chills, flank pain, and dysuria. Laboratory testing usually reveals hyperglycemia, leukocytosis, pyuria, an elevated blood urea nitrogen (BUN) level, and high serum creatinine level. Other, nonspecific symptoms such as abdominal pain, nausea, vomiting, and diarrhea can accompany acute pyelonephritis, as found in the reported case. The appropriate management of such serious infection requires combined medical and surgical treatment. In severe infection, nephrectomy should not be delayed. We report a case of EPN in a diabetic patient who presented with gastrointestinal symptoms. A high index of suspicion, coupled with a good imaging study [preferably computed tomography (CT) scanning] of the abdomen can lead to early diagnosis. Appropriate medical and surgical management have resulted in a successful outcome. © 2007 Lippincott Williams & Wilkins, Inc.