Simultaneous Diagnosis of Emphysematous Osteomyelitis and Emphysematous Pyelonephritis in a Diabetic Patient
Simultaneous Diagnosis of Emphysematous Osteomyelitis and Emphysematous Pyelonephritis in a Diabetic Patient
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DOI：
10.12659/ajcr.920006
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发表时间：
2019-12-02
影响因子：
1.2
通讯作者：
Lelekis, Moyssis
中科院分区：
文献类型：
--
作者：
Tatakis, Fotios-Panagiotis;Kyriazis, Ioannis;Lelekis, Moyssis
目的：罕见疾病背景：脊柱气肿性骨髓炎的特征是椎内或骨内空气。肺气肿性肾盂肾炎（EP）是产气微生物引起的肾实质和肾周组织的感染，以产气为特征。及时诊断并开始必要的治疗至关重要，因为这两种疾病都与高死亡率相关。 病例报告：一名 57 岁女性，因高血糖不受控制而到急诊科就诊，有 3 天突然出现虚弱、恶心、呕吐和腹泻的病史，并且跌倒与前一天相同。实验室检查显示白细胞增多、淋巴细胞减少、血小板减少、肾功能恶化和高血糖高渗非酮症状态。她接受了积极的静脉补液和胰岛素输注泵治疗。由于病情恶化，她接受了腹部和盆腔CT扫描，发现脊柱气肿性骨髓炎和气肿性肾盂肾炎。尽管进行了大力液体复苏和全身广谱抗生素治疗，患者病情仍进一步恶化，最终在48小时内死亡。 结论：这起致死性脊柱肺气肿性骨髓炎和EP病例提醒我们注意那些罕见的危及生命的疾病，这些疾病影响患有糖尿病和其他导致免疫抑制的病因的患者。本病例报告的目的是强调计算机断层扫描在诊断这些病症中的重要性和贡献，并强调这两种肺气肿实体罕见的共存。
Objective: Rare diseaseBackground: Emphysematous osteomyelitis of the spine is characterized by intravertebral or intraosseous air. Emphysematous pyelonephritis (EP) is the infection of the renal parenchyma and perirenal tissues caused by gas forming microorganisms and thus is characterized by gas formation. Prompt diagnosis and initiation of necessary treatment is crucial, as both entities are associated with high mortality rates.Case Report: A 57-year-old female with uncontrolled hyperglycemia presented to the emergency department with history of sudden onset of weakness, nausea, vomiting and diarrhea for 3 days and with a fall on the same level the previous day. Laboratory examinations revealed leukocytosis, lymphopenia, thrombocytopenia, deteriorated renal function, and hyperglycemic hyperosmolar non-ketotic state. She was placed on aggressive intravenous hydration and insulin infusion pump. Due to the deterioration of her medical condition, she underwent abdominal and pelvic CT scanning that revealed emphysematous osteomyelitis of the spine and emphysematous pyelonephritis. Despite vigorous fluid resuscitation and systemic broad-spectrum antibiotic therapy, the patient's condition deteriorated further and eventually led to death within 48 h.Conclusions: This case of fatal emphysematous osteomyelitis of the spine and EP serves as a significant reminder of those rare life-threatening entities, which affect patients with comorbidities, such as diabetes mellitus and other etiologies causing immunosuppression. The aim of the present case report is to highlight the importance and contribution of computed tomography in diagnosing these conditions and to emphasize the rare coexistence of these 2 emphysematous entities.