Emphysematous pyelonephritis caused by C. glabrata

Abstract Emphysematous pyelonephritis (EPN) is a rare acute necrotizing infection of the kidney and surrounding tissues, with gas in the renal parenchyma, collecting system or perirenal tissue. The bacterial etiology predominates; mainly Gram-negative bacilli; Candida spp. and C. albicans are rarely described. We describe a case of EPN caused by C. glabrata, sensitive to fluconazole in a young, hypertensive woman with undiagnosed diabetes mellitus (DM), with renal dysfunction upon admission; her abdominal CT scan found a volumetric increase in the left kidney, signs of gas collections and perirenal blurring. Despite the antimicrobial therapy instituted, due to clinical refractoriness, a double J catheter and subsequent total nephrectomy were indicated, with good postoperative evolution. Her uroculture showed C. glabrata sensitive to fluconazole, and the pathology study showed tubular atrophy and intense interstitial inflammatory infiltrate. Despite the serious, potentially fatal condition, we could control the infection and the patient recovered fully. Poor DM management is an important triggering factor, and it is of great relevance to identify the EPN through imaging exams due to the peculiarities of its clinical and potentially surgical management

摘要 气肿性肾盂肾炎（Emphysematous pyelonephritis, EPN）是一类罕见的肾脏及周围组织急性坏死性感染，以肾实质、集合系统或肾周组织内存在气体为特征。其病因以细菌感染为主，主要致病菌为革兰阴性杆菌；念珠菌属（Candida spp.）及白假丝酵母菌（C. albicans）相关病例鲜有报道。本文报告1例由光滑假丝酵母菌（C. glabrata）引发的EPN病例：患者为年轻女性，患有未确诊的糖尿病（Diabetes mellitus, DM）与高血压，入院时伴肾功能不全；腹部CT检查显示左肾体积增大、存在气体积聚征象及肾周模糊影。尽管已启动抗菌治疗，但因临床症状呈难治性，遂先行置入双J导管，后续行全肾切除术，术后恢复良好。患者尿培养结果提示光滑假丝酵母菌对氟康唑敏感，病理检查可见肾小管萎缩及显著的间质性炎性浸润。尽管该病病情危重且具有潜在致命性，但我们成功控制了感染，患者最终完全康复。糖尿病管理不佳是重要的诱发因素，结合其临床与手术治疗的特殊性，通过影像学检查识别气肿性肾盂肾炎具有重要临床价值。