Emphysematous pyelonephritis successfully treated by early intervention using a renoureteral catheter.

A 49-year-old woman with poorly controlled type 2 diabetes mellitus was admitted to hospital complaining of fever, vomiting, and lower abdominal pain. Laboratory investigation revealed leukocytopenia, high blood sugar, and pyuria. Pyelonephritis was then diagnosed. Escherichia coli was isolated from blood and urinary cultures. In spite of antimicrobial therapy, the patient's condition deteriorated. A computed tomography scan of the abdomen on the second day of hospitalization revealed the presence of air in the collecting system of the left kidney. Emphysematous pyelonephritis was diagnosed, and a renoureteral catheter was promptly inserted via the left ureter into the affected pelvis of the left kidney. Imipenem, cefotiam, and levofloxacin were administered during the clinical course. This early intervention and the appropriate antimicrobial therapy were effective in resolving the infection. Urinary tract infections should be carefully managed in patients with poorly controlled diabetes mellitus.