Emphysematous Pyelonephritis with Left Renal Vein Thrombosis-Case Report Successfully Treated by Conservative Methods

Emphysematous pyelonephritis (EP) is an acute and severe necrotizing urinary tract infection (UTI) mostly seen in poorly-controlled diabetic patients and urinary tract obstruction. 1 EP is a sudden onset infection that causes renal parenchymal necrosis, perinephric tissue damage, and gas production. 2 This uncommon and life-threatening condition was firstly described by Kelly and McCullum in 1898. 3 We hereby present a case of EP after manipulation of the urinary tract, currently a rare but one of the most serious complications of diabetes mellitus (DM). CASE REPORTA forty-nine years old woman was admitted to the hospital with unconsciousness, fever, and left-sided flank pain.Regarding her medical history, she was diagnosed 18 years before with Type 2 DM.At in-terrogatory, the family reported that patients did not use the advised medication and was not regularly controlled despite developing nonproliferative retinopathy over the years.One week before an uneventful left percutaneous nephrolithotomy (PCNL) was performed because of a urinary tract stone.Two days after the procedure she became febrile and unconscious and was diagnosed with a UTI.The patient was hospitalized and treated with Cefuroxime Axetil 250 mg (Bilim Pharmaceuticals Industry and Commerce Inc., Turkey) was administered "per os" twice a day for 5 days in another center.Because of the lack of improvement, the patient was referred to our center.At admission, her temperature was 38 °C, blood pressure 90/50 mmHg, pulse 110/bpm, body mass index (BMI)=25.3kg/m 2.The patient was pale and confused.Lung examination revealed crepitance on both basilary and middle zones; the cardiovascular