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hla · Credits: 2611 My Scrapbook

BACKGROUND

A 56-year-old man with a history of hepatitis C and diabetes mellitus presents to the emergency department (ED) with right flank pain and subjective fevers of 2-3 days’ duration. The patient describes his pain as being mild in intensity but constant and nonradiating, with a pressure-like quality. The patient takes 20 units of neutral protamine Hagedorn (NPH) insulin injected subcutaneously twice daily for his diabetes, but he states that his self-reported daily blood glucometer readings have been approximately 250-350 mg/dL for the past month.
On physical examination, the patient’s vital signs are a blood pressure of 100/60 mm Hg, a heart rate of 96 bpm, a respiratory rate of 16 breaths/min, and an oral temperature of 102.2°F (39.0°C). The cardiac and respiratory portions of the examination are unremarkable. The patient is noted to have tenderness in the right costovertebral angle. His abdominal examination is unremarkable for any tenderness to palpation, rebound, or guarding.

Clinically significant laboratory results include a white blood cell (WBC) count of 24.4 × 109/L, a blood urea nitrogen (BUN) concentration of 71 mg/dL, a creatinine level of 5.4 mg/dL, and a serum glucose level 629 mg/dL. The urinalysis reveals cloudy urine with copious WBCs, a glucose concentration of 100 mg/dL, a protein concentration of 100 mg/dL, and a large leukocyte esterase.

Renal ultrasonography is performed and reveals an abnormality of the right kidney (see Images 1-2). To further illustrate this abnormality, an abdominal computed tomography (CT) scan was obtained (see Image 3).

What is the diagnosis?
HINT
This condition most commonly occurs in patients with diabetes.
Please state your diagnosis and explain why.

rannye · Credits: 6634 My Scrapbook

pyelonephritis...HX & PE alone gives us the the diagnosis

Marzoukrz · Credits: 2496 My Scrapbook

Emphysematous cholecystitis due to gas forming bacteria

Marzoukrz · Credits: 2496 My Scrapbook

sorry i mean emphysematous pyelonephritis due to gas forming bacteria like clostridia

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