Bazargani Behnaz, Moghtaderi Mastaneh, Esfandiary Hassan, Ghanbarian Fatemeh, Samieefar Noosha
Pediatric Chronic Kidney Disease Research Center, Gene, Cell & Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Network of Interdiscplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
J Med Case Rep. 2025 Sep 26;19(1):454. doi: 10.1186/s13256-025-05537-z.
Emphysematous pyelonephritis is a life-threatening condition characterized by gas accumulation within the kidney and the surrounding tissues, often resulting in tissue necrosis. Although frequently reported in adults, emphysematous pyelonephritis is an extremely rare condition in children, with only a few documented cases in the literature. We present the case of a child with insulin-dependent diabetes mellitus who had initially been admitted with a diagnosis of diabetic ketoacidosis that was later revealed to be emphysematous pyelonephritis.
An Iranian 11-year-old girl with poorly controlled type 1 diabetes was referred to the Children's Medical Center with a computed tomography scan confirming emphysematous pyelonephritis (stage 4). The patient initially presented with abdominal and flank pain, fever, and fatigue, and the initial diagnosis was diabetic ketoacidosis. Despite undergoing management for diabetic ketoacidosis, the patient continued to exhibit signs of fever and illness. Further evaluation ruled out diabetic ketoacidosis, and active urine analysis indicated a kidney pathology. Imaging investigations confirmed the presence of gas within the pyelocaliceal system. In our center, the patient was treated with intravenous meropenem and vancomycin for 7 days and was discharged with improved health and normal kidney function.
This case underscores the significance of considering emphysematous pyelonephritis in children, particularly those with underlying conditions such as diabetes, even when initial presentations suggest other diagnoses such as diabetic ketoacidosis.
气肿性肾盂肾炎是一种危及生命的疾病，其特征是肾脏及周围组织内积聚气体，常导致组织坏死。尽管气肿性肾盂肾炎在成人中经常有报道，但在儿童中极为罕见，文献中仅有少数病例记载。我们报告一例患有胰岛素依赖型糖尿病的儿童病例，该患儿最初因糖尿病酮症酸中毒入院，后来被诊断为气肿性肾盂肾炎。
一名11岁的伊朗女孩，1型糖尿病控制不佳，被转诊至儿童医学中心，计算机断层扫描确诊为气肿性肾盂肾炎（4期）。该患者最初表现为腹痛、侧腹痛、发热和疲劳，初步诊断为糖尿病酮症酸中毒。尽管接受了糖尿病酮症酸中毒的治疗，但患者仍持续出现发热和疾病症状。进一步评估排除了糖尿病酮症酸中毒，尿液活性分析显示存在肾脏病变。影像学检查证实肾盂肾盏系统内有气体。在我们中心，该患者接受了静脉注射美罗培南和万古霉素治疗7天，出院时健康状况改善，肾功能正常。
本病例强调了在儿童中考虑气肿性肾盂肾炎的重要性，特别是对于患有糖尿病等基础疾病的儿童，即使初始表现提示其他诊断，如糖尿病酮症酸中毒。
