Fatal form of phaeochromocytoma presenting as acute pyelonephritis

We report the case of a young man who presented with a clinical picture of acute pyelonephritis. Within 3 h of admission, the patient developed acute respiratory distress associated with tachycardia and shock, and he was tran sferred to the intensive care unit. Mechanical ventilation of the lungs and symptomatic treatment were started immediately. Abdominal ultrasound revea led the presence of an adrenal tumour with central necrosis indicating a pr obable phaeochromocytoma. There was no sign of pyelonephritis. Ventricular fibrillation followed by asystole occurred soon after admission. The sudden ness of the patient's death did not allow time for further investigation an d therapy. The severity of the clinical signs was probably related to a mas sive release of catecholamines because of necrosis of the tumour, which may have been worsened by the diagnostic procedures performed to investigate t he clinical symptoms and signs of acute pyelonephritis.