Universidade Estadual do Oeste do Paraná (Unioeste), Centro de Ciências Médicas e Farmacêuticas (CCMF), Hospital Universitário do Oeste do Paraná (HUOP), Cascavel, PR, Brasil.
J Bras Nefrol. 2022 Jul-Sep;44(3):447-451. doi: 10.1590/2175-8239-JBN-2020-0184.
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.
气肿性肾盂肾炎（EPN）是一种罕见的肾脏和周围组织的急性坏死性感染，肾实质、集合系统或肾周组织中有气体。细菌病因占主导地位；主要为革兰氏阴性杆菌；也很少描述假丝酵母菌属和白色假丝酵母菌。我们描述了一例由近平滑假丝酵母菌引起的 EPN 病例，该患者为年轻的高血压女性，患有未确诊的糖尿病（DM），入院时肾功能不全；她的腹部 CT 扫描发现左肾体积增大，有气体积聚和肾周模糊的迹象。尽管进行了抗菌治疗，但由于临床耐药性，需要放置双 J 导管和随后进行全肾切除术，术后恢复良好。她的尿培养显示近平滑假丝酵母菌对氟康唑敏感，病理研究显示肾小管萎缩和强烈的间质炎症浸润。尽管病情严重，有潜在的致命危险，但我们可以控制感染，患者完全康复。DM 管理不善是一个重要的触发因素，通过影像学检查识别 EPN 非常重要，因为其临床和潜在的手术管理具有特殊性。
