IngentaConnect Case of emphysematous pyelonephritis in a renal allograft

Authors: Fujita, Shiro¹; Watanabe, Jota²; Reed, Alan I¹; Hemming, Alan W¹; Solis, Diego¹; Netzel, Tisha C²; Banull, Katherine³; Schain, Denise C³; Howard, Richard J¹

Source: Clinical Transplantation, Volume 19, Number 4, August 2005 , pp. 559-562(4)

Publisher: Blackwell Publishing

Abstract:

Fujita S, Watanabe J, Reed AI, Hemming AW, Solis D, Netzel TC, Banull K, Schain DC, Howard RJ. Case of emphysematous pyelonephritis in a renal allograft.

Clin Transplant 2005: 19: 559–562. © Blackwell Munksgaard, 2005 Abstract:

Emphysematous pyelonephritis is a rare, but serious complication after renal transplantation. This is a case report of a 49-yr-old female who had a renal transplant for diabetic nephropathy. She presented to ER with about 1 wk history of right lower abdominal pain and fever 15 months after the transplant. She had gross hematuria and mental status changes just prior to presentation. A computed tomography (CT) scan of the abdomen showed extensive retroperitoneal and extraperitoneal air dissecting from the transplanted kidney in the right lower quadrant to the level of the mediastinum. There was air in the urinary bladder. These findings were highly suggestive of extensive emphysematous pyelonephritis. The patient was taken to the operating room emergently and underwent a transplant nephrectomy. Blood culture and urine culture were subsequently positive for Salmonella (serogroup O 6, 8 or C2). Initial blood culture also yielded Enterobacter cloacae. The patient was treated with imipenem, cefepime, flagyl, and diflucan empirically: this was later changed to complete a 6-wk course of ciprofloxacin upon discharge. Her hospital course was complicated by a urinary leak; she was discharged to home on day 21. This is the 12th reported case of emphysematous pyelonephritis occurred in a renal transplant recipient.

Keywords: emphysematous pyelonephritis; renal transplantation

Document Type: Research article

DOI: 10.1111/j.1399-0012.2005.00264.x

Affiliations: 1: Division of Transplantation, Department of Surgery 2: Department of Pathology, Immunology and Laboratory Medicine 3: Division of Infectious Diseases, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA

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