Emphysematous pyelonephritis is an uncommon and, but life-threatening necrotizing inflammation of renal parenchyme and perinephric tissue by gas-forming organisms. This disease is encountered mainly in patients with uncontrolled diabetes mellitus and/or urinary tract obstruction etc. Clinically, it appears as an acute severe clinical pyelonephritis that needs emergency care with poor prognosis. Though the pathogenesis of this disease is still pooly understood, radiographic demonstration of gas shadow in renal parenchyme and peri- nephritic tissue establishes the diagnosis of emphysematous pyelonephritis. The identification of this finding has been believed to consider incision and drainage or nephrectomy in addition to medical treatment, because of high mortality rate of this disease in spite of vigorous medical management. We herein present 1 diabetic patient with emphysematous pyelonephritis who responded to medical treatment alone. The patient was treated with antibiotics alone, the clinical signs and laboratory findings were improved, CT scan 1 month after medical treatment revealed absence of gas in the renal pelvis.
Anti-Bacterial Agents ; Diabetes Mellitus ; Diagnosis ; Drainage ; Emergency Medical Services ; Humans ; Inflammation ; Kidney Pelvis* ; Mortality ; Nephrectomy ; Prognosis ; Pyelonephritis* ; Tomography, X-Ray Computed ; Urinary Tract

Hypereosinophilic syndrome is characterized by prolonged eosinophilia of blood and tissue without an identifiable underlying cause and multiorgan system dysfunction by eosinophil-related tissue damage to variable organs: liver, heart, lung, kidney, gastrointestinal tract, skin, nerve. Some case of hypereosinophilic syndrome with hepatic and gastrointestinal involvement have been reported, but not much. We are reporting a case of hypereosinophilic syndrome with hepatic and gastrointestinal involvement in 56-year-old man who presented general weakness and epigastric discomfort. In abdominal US, CT and MRI, intrahepatic multifocal ill-defined lesions were detected. The patient was treated with prednisolone for 16 weeks and recovered from eosinophilia and gastric involvement. A gastric biopsy was taken to confirm recovery. Also, the ill-defined lesions in US and CT disappeared after treatment.
Biopsy ; Eosinophilia ; Gastrointestinal Tract ; Heart ; Humans ; Hypereosinophilic Syndrome* ; Kidney ; Liver ; Lung ; Magnetic Resonance Imaging ; Middle Aged ; Prednisolone ; Skin