Emphysematous pyelonephritis related to specific gas-forming Escherichia coli without diabetes mellitus

A 60-year-old-man without a history of diabetes mellitus, or invasive manip ulation or obstruction of the urinary tract was admitted for septic shock, Type I emphysematous pyelonephritis was clear in this case: gas within the renal parenchyma extending into the subcapsular region and the perirenal sp ace was present on spiral computerised tomography (CT). Surgical nephrectom y was performed because biochemistry, urography and CT identified a damaged non-functioning left kidney. The outcome was favourable. All urine, blood and nephrectomy specimen cultures were positive for a specific Escherichia coli which produced a high level of gas compared to a reference E. coli str ain in the same standard medium, despite the absence of diabetes mellitus. Certain strains of bacteria are able to produce high levels of nitrogen, ca rbon dioxide and hydrogen and such fermentation in the absence of a high gl ucose serum level might explain the acute gas-producing bacterial renal inf ection.