Serious complications of urinary tract infection in diabetes: emphysematous pyelonephritis and endogenous endophthalmitis

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.