Emphysematous pyelonephritis or something else?
Published in the present the journal Urology Case Reports, the authors report a case of 67-year old male who presented with findings of emphysematous pyelonephritis (EPN) but was ultimately found to have SCC of the renal pelvis.

The patient presented with left flank pain and fever, evaluating since one week, associated with anorexia, there was no history of gross hematuria, renal calculi, or urinary tract infections. On initial presentation the patient was lethargic, febril (38,5 °C), blood pressure 90/07 mmHg with accelerating heart rate 110 bpm.

On per abdominal examination, tenderness was present on the left loin region. His laboratory evaluations showed an elevated white blood cell count of 17 × 103, high level of C-reactive protein (110 mg/dl), and blood sugar was within the normal rate. Urinalysis showed no bacterial growth. A CT-scan showed proximal ureteral calculi, measuring 14 mm, causing marked hydronephrosis with diffuse parenchymal thinning with gas within the parenchyma and the posterior perirenal tissue, consistent with EPN.

After medical optimization, the patient underwent a left lombotomy, for the high suspicion of EPN causing severe sepsis, per operative findings revealed dilated kidney with atrophic parenchyma, intensive perinephric inflammation, and a reno-colic fistula, a left nephrectomy was performed with partial colectomy with left sided transverse colostomy.

The surgical specimen contained a mass arising in the renal pelvis, penetrating the renal capsule, and invading the adherent colon. Histopathological evaluation revealed a stage pT4 well differentiated SCC. The patient died two weeks after the surgery.

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