Case Report: PDF OnlyEmphysematous Pyelonephritis Presenting as Necrotizing Fasciitis of the LegYe, Yu-Xiong; Wen, Yao-Ko* Author Information Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C. *Correspondence to: Dr Yao-Ko Wen, Division of Nephrology, Department of Medicine, Changhua Christian Hospital, 135, Nanhsiao Street, Changhua 500, Taiwan, R.O.C. E-mail: [email protected] Received: May 28, 2008; • Accepted: October 17, 2008. Journal of the Chinese Medical Association: March 2009 - Volume 72 - Issue 3 - p 160-162 doi: 10.1016/S1726-4901(09)70044-9 Metrics Abstract We report a 50-year-old man with poorly controlled diabetes mellitus who presented with a painful, swollen right leg. He had also experienced right flank pain for 1 week prior to admission. Physical examination was notable for tenderness over the right flank. The right leg was diffusely swollen and exquisitely tender to touch, with palpable crepitance. Laboratory tests revealed leukocytosis and pyuria. Computed tomography showed a right ureteral stone with hydronephrosis and characteristic findings of emphysematous pyelonephritis. Furthermore, a right perirenal gas-forming abscess with extension to the right leg was noted. The patient was successfully treated with antibiotic therapy, aggressive control of blood sugar, percutaneous drainage of the hydronephrosis and perirenal abscess, and aggressive debridement of the leg. © 2009 by Lippincott Williams & Wilkins, Inc.