A rare presentation of systemic emphysematous infections secondary to Klebsiella pneumoniae bacteremia in a diabetic patient

Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review

BACKGROUND

Emphysematous pyelonephritis (EPN) is a rare but fatal necrotic infection of the kidney, which usually leads to septic shock. Therefore, early diagnosis and optimized therapy are of paramount importance. In the past two decades, point-of-care ultrasound (POCUS) has been widely used in clinical practice, especially in emergency and critical care settings, and helps to rapidly identify the source of infection in sepsis. We report a rare case in which a “falls” sign on POCUS played a pivotal role in the early diagnosis of EPN.

CASE SUMMARY

A 57-year-old man presented with fever and lumbago for 3 d prior to admission. He went to the emergency room, and the initial POCUS detected gas bubbles in the hepatorenal space showing a hyperechoic focus with dirty shadowing and comet-tail artifacts. This imaging feature was like a mini waterfall. His blood and urine culture demonstrated Escherichia coli bacteremia, and EPN associated with septic shock was diagnosed. The patient did not respond to broad-spectrum antibiotic treatment and a perirenal abscess developed. He subsequently underwent computed tomography-guided percutaneous catheter drainage, and fully recovered. We also review the literature on the sonographic features of POCUS in EPN.

CONCLUSION

This case indicates that a “falls” sign on POCUS facilitates the rapid diagnosis of severe EPN at the bedside.

Distant metastatic foci of infection in adult patients with diabetic foot - not as rare as we think?: case series and review of the literature

BACKGROUND

Diabetic foot is one of the common complications of diabetes mellitus. We report clinical and microbiological characteristics and outcomes of cases with distant metastatic foci of infection arising from diabetic foot.

METHODS

Retrospective review of adult patients with diabetic foot infection or diabetic foot ulcer who demonstrated distant metastatic foci of infection between August 2017 and December 2019. We performed a literature search of similar cases published until June 2020.

RESULTS

Twelve patients with diabetic foot infection or diabetic foot ulcer with distant metastatic foci of infection were identified. The median age of patients was 67.5 years (range 60.5-73.5 years) and 11 males. The most common distant metastatic foci of infection included endocarditis (n = 7) followed by septic arthritis (n = 3) and spine infections (n = 2). Five patients had multiple site and organ involvement. Staphylococcus aureus was the only organism isolated from blood (n = 11), diabetic foot (n = 7), and metastatic foci (n = 8) sources. Three patients died and three had a relapse of distant metastatic foci of infection. Thirty-eight cases were identified in the literature with similar characteristics.

CONCLUSIONS

Prevalence of distant metastatic foci of infection in adult patients with diabetic foot and burden of illness, in terms of mortality, morbidity, and length of hospital stay, appears to be underreported in the literature. A large prospective study is needed to assess the true prevalence of complications, associated risk factors, outcomes and prognostic factors.