alexa Emphysematous Pyelitis Disguised as Cholestasis and Jaundice
ISSN: 2165-7920

Journal of Clinical Case Reports
Open Access

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Case Report

Emphysematous Pyelitis Disguised as Cholestasis and Jaundice

Jennifer Hines* and Richard Shellenberger

St. Joseph Mercy Health System-Ann Arbor, Ypsilanti, MI, USA

*Corresponding Author:
Hines J
St. Joseph Mercy Health System-Ann Arbor, Ypsilanti, MI, USA
Tel: 734-712-3456
E-mail: [email protected]

Received date: June 30, 2016; Accepted date: August 10, 2016; Published date: August 14, 2016

Citation: Hines J, Shellenberger R (2016) Emphysematous Pyelitis Disguised as Cholestasis and Jaundice . J Clin Case Rep 6:846. doi: 10.4172/2165-7920.1000846

Copyright: © 2016 Hines J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Emphysematous pyelitis is a rare infection of the renal pelvis occurring alone or in association with pyelonephritis. The most common cause is E. coli and diabetes is the strongest risk factor. In a retrospective review including 48 patients who were diagnosed with either emphysematous pyelitis or pyelonephritis, the mean patient age was 60 years old and women outnumbered men 6:12. The most common initial symptoms include fever, dysuria, abdominal pain, and flank pain. The most frequent organ system involvement is hematologic and renal. Our patient, a 76 year old female, with no past medical history, presented with progressive weakness followed by the onset of jaundice. Her exam was notable for hypertension but no fever, jaundice, epigastric/right upper quadrant abdominal tenderness or peritoneal signs. Labs were remarkable for a profound leukocytosis, anemia, cholestasis, and an elevated creatinine. An abdominal ultrasound did not reveal cholecystitis or a common bile duct obstruction. Empiric antibiotics to include Ceftriaxone and Flagyl were started for possible cholangitis. On hospital day two, an abdominal endoscopic ultrasound was performed in lieu of a contrast study as renal function had worsened. This examination was normal. A non-contrasted CT scan of the abdomen and pelvis demonstrated the unusual findings of emphysematous pyelitis with a surrounding fluid collection concerning for a perinephric abscess. Subsequent management included placement of a percutaneous nephrostomy tube and antibiotics. Emphysematous pyelitis presenting as cholestasis is a novel clinical presentation of a rare illness.


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