BMJ Case Reports 2018; doi:10.1136/bcr-2018-225931
  • Rare disease

Emphysematous pyelonephritis: outcomes of conservative management and literature review

  1. Constantinos Missouris1,2
  1. 1Department of Cardiology, Frimley Health Foundation Trust, Slough, Berkshire, UK
  2. 2Medical School, University of Cyprus, Nicosia, Cyprus
  1. Correspondence to Dr Constantinos Missouris, dinos.missouris{at}
  • Accepted 26 August 2018
  • Published 12 September 2018


Emphysematous pyelonephritis (EPN) is a rare, necrotising infection of the renal parenchyma, predominantly associated with Escherichia coli infection and unless promptly recognised and dealt with, it carries a poor prognosis. The current treatment is one of antimicrobial therapies together with nephrectomy in a majority of patients. We report an elderly man with multiple comorbidities with a diagnosis of EPN whose condition improved with antimicrobial and supportive therapy, and no surgical intervention was required.


  • Contributors SD: main author; the first person to meet the patient described in this case report when he was admitted to the ward; involved in the formation of the diagnosis by imaging and liaised with the various specialties to guide treatment; assessed the literature and conducted a full literature review; wrote the case and the literature review. CM: one of the supervisors; edited the work of SD and guided him in the first instance; helped to shape the paper and ensure that it read well, made sense and was appropriately referenced. FZ: second author; Stuart’s registrar; primarily, he was key in making the diagnosis having been the first person to correctly interpret the abdominal X-ray which was performed when the patient was septic; second person to proof-read the paper and guide the aspect of the literature review which focuses on image diagnosis in persons with this condition; helped to look through the data from previous cases and assess the best modality for image diagnosis, which we have discussed in the paper. AN: third author, is Stuart’s official educational supervisor and was the consultant on the ward when this diagnosis was made. He was key in making the final decision in terms of management when the data were presented to him; third person to proof-read the paper; looked through the previous case reports and helped to assimilate the information and determine if the conclusions were accurate and supported by the clinical picture, the biochemistry and the imaging; he was key in assessing the value of discussing disease severity markers from the literature.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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