171 Asymptomatic Emphysematous Pyelonephritis

Introduction Emphysematous pyelonephritis is a rare severe gas-forming infection of the renal parenchyma and its surrounding areas. It is usually common in poorly controlled diabetic patients or associated with urinary stones. We present a rare case of asymptomatic emphysematous pyelonephritis, which was diagnosed incidentally during a follow-up CT scan for the patient and treated successfully with a total of 10 weeks of antibiotics. Presentation A male patient in his 70s with a history of poorly controlled type 2 diabetes mellitus, chronic kidney disease, and benign prostatic hyperplasia was referred to the hospital due to findings of emphysematous pyelonephritis on a follow-up CT scan of the kidneys, ureters, and bladder (CT KUB). Discussion Emphysematous urinary tract infections are caused by gas-forming organisms and are categorized based on how the gas is distributed in the urinary tract. The causal agent of infection for emphysematous pyelonephritis is mostly Escherichia coli and Klebsiella pneumonia. To our knowledge, this is the second case of asymptomatic emphysematous pyelonephritis that was treated with antibiotics and without intervention. Conclusions Asymptomatic emphysematous pyelonephritis is rare, with only two case reports in the literature. The characteristics of asymptomatic emphysematous pyelonephritis have not been well understood due to their rare occurrence. It may serve as the very first sign of the development of sepsis or remain dormant while undergoing medical treatment. successful management of asymptomatic emphysematous pyelonephritis with a prolonged course of antibiotics can be done in very selected cases with careful monitoring.