Is emphysematous pyelitis a precursor lesion of emphysematous pyelonephritis? A case report of bilateral emphysematous pyelitis caused by extended‑spectrum beta‑lactamase Escherichia coli and literature review




Eastern Idaho Regional Medical Center

Document Type

Case Report

Publication Date



e. coli, Escherichia coli, urinary tract infection, EP, EPN, pneumaturia, case reports


Bacterial Infections and Mycoses | Infectious Disease | Urology


The presence of air in different parts of renal excretory system needs accurate assessment, and careful consideration as its progression to renal parenchyma can lead to fulminant course with substantial mortality. Bilateral emphysematous pyelonephritis is a well‑known entity, but bilateral emphysematous pyelitis (EP) along with emphysematous cystitis is extremely rare. An internet search with the term “bilateral emphysematous pyelitis” and “bilateral emphysematous pyelitis and ureteritis with cystitis” only found three case reports in English. We present an interesting case of bilateral EP, ureteritis, and cystitis in a nondiabetic male patient without any history of immunodeficiency (HIV or chronic steroid use) but with a history of nonobstructing bilateral multiple renal calculi who was successfully managed medically. EP, if diagnosed early and managed properly, has an excellent prognosis with complete recovery following medical treatment. The following core competencies are addressed in this article: Practice‑Based Learning and Improvement, Patient care and Procedural skills, Medical Knowledge.

Publisher or Conference

International Journal of Academic Medicine