Abdominal Pain and Fever in an Elderly Patient with Diabetes Mellitus

Prakash Khetan, Vishal Ramteke, Jitendra Ashtekar
2020 Kidney360  
A 62-year-old man presented to the emergency department with a 5-day history of severe abdominal pain with low-grade fever. Medical history included diabetes mellitus and hypertension. He had tachycardia, hypotension, and diffuse abdominal tenderness. Investigations showed white blood cell counts of 22,400/mm 3 (4000-10,000/mm 3 ), blood urea of 180 mg/dl (9-43 mg/dl), creatinine of 1.8 mg/dl (0.66-1.25 mg/dl), and procalcitonin of 180 ng/ml (,0.5 ng/ml). Urinalysis showed plenty of white blood
more » ... enty of white blood cells and red blood cells on microscopy. Contrast-enhanced computed tomography scans showed multiple air bubbles in the bladder wall, suggestive of emphysematous cystitis (EC) ( Figure 1A) , with tracking of the gas in the pelvicalyceal system of the left kidney ( Figure 1B) . Two illdefined saccular outpouchings arising from the lateral wall of the infrarenal aorta, with retroperitoneal air bubbles suggestive of mycotic aneurysms, were also noted ( Figure 1A) . A left ureteric double-J stent and urethral catheter were inserted and the patient was administered intravenous meropenem. Urine and blood cultures grew Escherichia coli (.100,000 colonies) sensitive to carbapenems. The patient developed worsening sepsis, which was complicated by severe kidney injury, and was started on continuous RRT. The patient eventually died due to septic shock.
doi:10.34067/kid.0002402020 fatcat:uydyd47375e7rlesz2hd5rsyvi