575: emphysematous kidney and pyelonephritis in a diabetic woman managed with empagliflozin
Abstract
Introduction: Diabetes mellitus is considered one of the major risk factors for complicated urinary tract infections including emphysematous pyelonephritis. Description: We report a case of a 60-year-old woman with history of difficult to control type 2 diabetes melllitus (Hemoglobin A1C 14%) managed with dulaglutide, empagliflozin, and insulin. She had left flank pain radiated to the groin, vomiting, dizziness, and lightheadedness for two days, with absence of urinary symptoms or fever. On physical exam she had costovertebral tenderness, tachycardia, and hypotension which did not respond to crystalloids and required pressors. Patient developed septic shock, and had acute kidney injury, lactic acidosis (8.4 mmol/L), thrombocytopenia, and significant glycosuria (>500 mg/dL). CT imaging of the abdomen showed severe emphysematous pyelonephritis of the left kidney involving 80% of the parenchyma, and radiological signs of ischemic colitis with presence of portal venous gas and air within branches of the superior mesenteric vein. Initial antibiotic treatment was with cefepime, vancomycin, and metronidazole. Emergent nephrectomy was necessary, and bowel was found to be viable. Postoperative management in ICU was required. Blood cultures revealed Escherichia coli, therefore antibiotics were deescalated. Discussion: Sodium-glucose cotransporter 2 (SGLT2) inhibitors such as Empagliflozin are associated with severe urinary tract infections including pyelonephritis. This is the first…
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