Emphysematous pyelonephritis - renal graft

Presentation

Patient with a history of end-stage renal disease secondary to ADPKD, who underwent a kidney transplant in the right iliac fossa. An early thrombosis of the graft was diagnosed by Doppler US and CT. Transplantectomy was postponed because of a clinically diagnosed prostatitis. 2 weeks later presents fever and pelvic pain, with blood tests showing leukopenia and anemia. A CT scan was performed.

Patient Data

Age: 50 years
Gender: Male
CT

Abdomen and pelvis

Portal-venous phase CT scan shows enlarged native kidneys in a patient with ADPKD. Right iliac fossa graft shows no vascularization in relation to previously known arterial and venous thrombosis (with a small part of the renal artery of the graft filled with contrast). There is air in the excretory system of the transplant and a perirenal fluid collection with air and enhancing walls. The findings were reported as a perirenal abscess, possibly secondary to emphysematous pyelonephritis of the renal graft.

Case Discussion

Because of the CT findings percutaneous drainage was performed, obtaining 100cc of purulent fluid consistent with the suspicion of a perirenal abscess.

Emphysematous pyelonephritis is an uncommon severe infection of the kidney, usually seen in diabetic but also immunocompromised patients. In this case, there was leukopenia and the patient was still undergoing immunosuppressive therapy because of the transplant. If left untreated, it carries a high risk of sepsis and death.

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Case information

rID: 72595
Published: 17th Dec 2019
Last edited: 20th Dec 2019
System: Urogenital
Inclusion in quiz mode: Included
Institution: Fundacio Puigvert

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