Ernstige complicaties van urineweginfectie bij diabetes: Emfysemateuze pyelonefritis en end ogene end oftalmitis

Translated title of the contribution: Serious complications of urinary tract infection in diabetes: Emphysematous pyelonephritis and endogenous endophthalmitis

Michelle J. Klouwens, Willem L. Blok, Antonella N. Witmer, C. J W Verouden, Marco Mura

Research output: Contribution to journalArticle

Abstract

Introduction Severe infectious complications may occur in poorly regulated diabetic patients. In most cases treatment will lead to full recovery. Here we describe a patient with urosepsis complicated by emphysematous pyelonephritis (EPN) and endogenous endophthalmitis. Case description A 42-year-old woman with uncontrolled diabetes presented with a ketoacidosis and right flank pain due to an urosepsis with Escherichia coli (E. coli). Ultrasonography and CT scan of the abdomen showed features of emphysematous pyelonephritis of the right kidney with gas in the renal parenchyma. Subsequently the patient complained of pain and photophobia of the left eye, diagnosed as an endogenous endophthalmitis with a cloudy cornea, hypopyon en loss of details of the iris. Confirmation of the diagnosis and treatment consisted of vitrectomy of the left eye, silicone oil injection and intravitreal antibiotics. E. coli was isolated from the vitreous fluid. Pyelonephritis was treated with systemic antibiotics and percutaneous drainage. Patient follow up learned that she had no light perception of the left eye and a non- functional right kidney. Conclusion Both endogenous endophthalmitis and emphysematous pyelonephritis are rare complications of infection, which are sight- and lifethreatening. Treatment of endogenous endophthalmitis comprises both intravitreal and systemic therapy and has a poor visual prognosis despite aggressive therapy. Treatment of EPN consists of antibiotic therapy, early percutaneous drainage and nephrectomy when indicated. With the increasing number of diabetics we should be aware of the occurrence of rare infectious complications.

Original languageDutch
Article numberA5243
JournalNederlands Tijdschrift voor Geneeskunde
Volume157
Issue number13
StatePublished - 2013
Externally publishedYes

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Endophthalmitis
Pyelonephritis
Urinary Tract Infections
Anti-Bacterial Agents
Kidney
Therapeutics
Drainage
Escherichia coli
Silicone Oils
Flank Pain
Photophobia
Ketosis
Intravitreal Injections
Vitrectomy
Iris
Nephrectomy
Abdomen
Cornea
Ultrasonography
Gases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Klouwens, M. J., Blok, W. L., Witmer, A. N., Verouden, C. J. W., & Mura, M. (2013). Ernstige complicaties van urineweginfectie bij diabetes: Emfysemateuze pyelonefritis en end ogene end oftalmitis. Nederlands Tijdschrift voor Geneeskunde, 157(13), [A5243].

Ernstige complicaties van urineweginfectie bij diabetes : Emfysemateuze pyelonefritis en end ogene end oftalmitis. / Klouwens, Michelle J.; Blok, Willem L.; Witmer, Antonella N.; Verouden, C. J W; Mura, Marco.

In: Nederlands Tijdschrift voor Geneeskunde, Vol. 157, No. 13, A5243, 2013.

Research output: Contribution to journalArticle

Klouwens, Michelle J. ; Blok, Willem L. ; Witmer, Antonella N. ; Verouden, C. J W ; Mura, Marco. / Ernstige complicaties van urineweginfectie bij diabetes : Emfysemateuze pyelonefritis en end ogene end oftalmitis. In: Nederlands Tijdschrift voor Geneeskunde. 2013 ; Vol. 157, No. 13.
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abstract = "Introduction Severe infectious complications may occur in poorly regulated diabetic patients. In most cases treatment will lead to full recovery. Here we describe a patient with urosepsis complicated by emphysematous pyelonephritis (EPN) and endogenous endophthalmitis. Case description A 42-year-old woman with uncontrolled diabetes presented with a ketoacidosis and right flank pain due to an urosepsis with Escherichia coli (E. coli). Ultrasonography and CT scan of the abdomen showed features of emphysematous pyelonephritis of the right kidney with gas in the renal parenchyma. Subsequently the patient complained of pain and photophobia of the left eye, diagnosed as an endogenous endophthalmitis with a cloudy cornea, hypopyon en loss of details of the iris. Confirmation of the diagnosis and treatment consisted of vitrectomy of the left eye, silicone oil injection and intravitreal antibiotics. E. coli was isolated from the vitreous fluid. Pyelonephritis was treated with systemic antibiotics and percutaneous drainage. Patient follow up learned that she had no light perception of the left eye and a non- functional right kidney. Conclusion Both endogenous endophthalmitis and emphysematous pyelonephritis are rare complications of infection, which are sight- and lifethreatening. Treatment of endogenous endophthalmitis comprises both intravitreal and systemic therapy and has a poor visual prognosis despite aggressive therapy. Treatment of EPN consists of antibiotic therapy, early percutaneous drainage and nephrectomy when indicated. With the increasing number of diabetics we should be aware of the occurrence of rare infectious complications.",
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