Unusual bacterial infections of the urinary tract in diabetic patients—rare but frequently lethal

(Section Editor: K. Kühn) A 54‐year‐old, poorly compliant, insulin‐requiring, diabetic man, who was also known to have a history of alcohol abuse, was referred to hospital with a 10‐day history of progressive left‐sided abdominal and loin pain, dysuria and fever. The onset of pneumaturia had prompted him to seek medical advice. Physical examination revealed an obese, dehydrated, ill‐looking man with a temperature of 40°C. The blood pressure was 100/50 mmHg and pulse 105/min. He was markedly tender over the left side of the abdomen, and although bowel sounds were scanty there was no peritonism. Pertinent laboratory investigations showed a peripheral white cell count of 26×109/1, serum creatinine 185 μmol/l, urea 31 mmol/l and the glucose was 24 mmol/l. An IVU showed gas distending the left renal pelvis and ureter (Figure 1). Gas was also present in the renal parenchyma, extending into surrounding tissues, and was best seen on a CT scan (Figure 2). E. coli was isolated subsequently from both urine and blood cultures.