Emphysematous Pyelonephritis—an Unexpected Cause of Extensive Subcutaneous Emphysema: Case Report

Emphysematous pyelonephritis (EPN) can be lethal and organ threatening if not recognized and treated promptly. We report a case of EPN presenting with extensive subcutaneous emphysema. A 42-year-old patient presented with severe sepsis and impending diabetic ketoacidosis. Investigations showed ruptured right EPN which resulted in pneumo-retroperitoneum, pneumo-mediastinum, and extensive subcutaneous emphysema. Emergency open retroperitoneal surgical drainage in addition to targeted antibiotics was started. Patient recovered well clinically and radiologically without a need for nephrectomy. Prompt diagnosis and timely treatment are of utmost importance. Clinical suspicion should be heightened in at-risk patients who present in sepsis state with a diagnosis of pyelonephritis or those who are not responding to the routine management of pyelonephritis.