We present a case of a 60-year-old male who presented with fever, shortness of breath, left upper quadrant pain accompanied by rigors and chills with a two-week history of productive cough. He had left upper quadrant tenderness and bilateral chest crepitations. The patient became tachypneic, dyspneic, and rapidly progressed to septic shock. Chest x-ray findings of bilateral pulmonary infiltrates on admission were not correlating with the severity of his clinical picture, and blood glucose levels were very high despite a negative prior history of diabetes. Abdominopelvic computed tomography (CT) scans revealed left-sided emphysematous pyelonephritis, which was promptly managed by intravenous antibiotics and CT-guided percutaneous drainage, in addition to glycemic control. This was followed by clinical improvement and resolution of the sepsis. This case sheds light on a possible life-threatening manifestation of the hematogenous spread of pneumonia in uncontrolled diabetic patients, and can even be a de novo presentation of diabetes.
【저자키워드】 Pneumonia, Sepsis, diabetes, pyelonephritis, Diabetes complications, klebsiella pneumonia, emphysematous pyelonephritis, 【초록키워드】 severity, cough, Spread, Computed tomography, clinical picture, Chest, Fever, male, Patient, Pain, Septic shock, Clinical improvement, Admission, glycemic control, diabetic patients, blood glucose, Shortness of breath, life-threatening, dyspneic, chill, de novo, intravenous antibiotics, rigor, addition, accompanied, bilateral pulmonary infiltrate, hematogenous, progressed, 【제목키워드】 review, literature, report, presentation, Bilateral, Emphysematous,