Emphysematous pyelonephritis is a rare, life-threatening necrotizing infection of the kidney typically associated with poorly controlled diabetes. While usually caused by gas-producing bacteria like E. coli, a new case report documents an unusual presentation involving Enterococcus species that mimicked acute pancreatitis.
A 56-year-old woman with uncontrolled Type 2 diabetes presented with severe epigastric pain, vomiting, and sepsis. Initial labs confirmed acute pancreatitis and Stage 2 acute kidney injury. However, standard etiologies for pancreatitis were excluded. A contrast-enhanced CT scan subsequently revealed gas within the right renal parenchyma, confirming Class 2 emphysematous pyelonephritis despite the absence of classic urinary symptoms.
Urine cultures identified Enterococcus species, a pathogen rarely implicated in this condition due to its minimal gas production. The patient was successfully treated with conservative management, including renal-adjusted ampicillin and strict glycemic control. She avoided surgical intervention or dialysis and achieved full clinical recovery within nine days.
This case underscores the necessity of broad differential diagnoses and early advanced imaging for diabetic patients presenting with abdominal pain. Clinicians must recognize that overlapping pathologies can coexist and that atypical pathogens may drive severe infections even when initial presentations suggest alternative diagnoses.