Emphysematous Pyelonephritis in a Renal Transplant Patient

Emphysematous pyelonephritis (EPN) is a necrotizing bacterial infection of the kidney that is cau-sed by gas-forming organisms. We report a case of a 58-year-old man with a renal transplant who presented to the emergency room with nausea, vomiting and right lower quadrant abdominal pain. At the time of presentation, he was hemodynamically stable, and the abdominal examination was significant for tenderness over the allograft. Urinalysis was positive for large amounts of leukocyte esterase and white blood cells. He received empiric antibiotic coverage with piperacillin/tazobac-tam. Over the following 24 hours, the patient developed septic shock manifested by hemodynamic instability. A non-contrast CT scan of the abdomen and pelvis elucidated a heterogeneous gas con-taining collection in the allograft. Emergent transplant nephrectomy was performed. Postopera-tively, the patient rapidly recovered and was subsequently discharged home to commence outpa-tient hemodialysis. A review of the literature suggests that early recognition of the severity of EPN as manifested by hemodynamic instability dictates emergent transplant nephrectomy as the treat-ment of choice