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A Rare Case of Acute Pyelonephritis Leading to Bilateral Subcapsular Renal Hematoma: A Case Report

급성 신우신염에 의한 양측 신피막하혈종 1예

  • Hae Won Park (Division of Nephrology, Department of Internal Medicine, Cheju Halla General Hospital) ;
  • Minsuk Seo (Division of Nephrology, Department of Internal Medicine, Cheju Halla General Hospital) ;
  • Chung Sik Lee (Division of Nephrology, Department of Internal Medicine, Cheju Halla General Hospital)
  • 박혜원 (제주한라병원 신장내과) ;
  • 서민석 (제주한라병원 신장내과) ;
  • 이충식 (제주한라병원 신장내과)
  • Received : 2023.11.07
  • Accepted : 2023.12.29
  • Published : 2024.06.01

Abstract

This case underscores the rarity of bilateral subcapsular renal hematoma (SCH) as a complication of acute pyelonephritis, and this is the first reported case in South Korea. SCH can have various underlying causes, including cysts, bleeding tendencies, cancer, vascular diseases and, less commonly, infections. A patient with uncontrolled diabetes mellitus and alcohol dependency presented with weakness. Bilateral SCH from acute pyelonephritis was diagnosed and treated with antibiotics and renal replacement therapy. Despite improved renal function, 30-day bilateral percutaneous drainage was necessary due to a persistent fever and elevated infection markers, resulting in a bloody, pus-like discharge. This case report sheds light on the rare etiology of bilateral SCH as a result of acute pyelonephritis. It serves as a reminder of the critical importance of timely intervention, to prevent deteriorating outcomes.

SCH는 주로 낭종, 출혈 경향, 암, 혈관질환에 의해 발생하나 드물게 감염에 의해 발생할 수 있다. 본 증례는 기저질환으로 조절되지 않는 당뇨, 음주력이 있는 환자에서 급성 신우신염의 합병증으로 양측 SCH가 발생한 국내 첫 보고이다. CT를 통하여 양측 SCH를 진단하였고 원인 감별을 위한 검사 진행 후 감염이 원인임을 확인하였다. 항생제 치료와 더불어 패혈증, 파종성 혈관 내 응고에 대해 신대체 요법 진행 후 신기능 및 감염 소견이 호전되어 중단하였고 이후 양측 PCD를 통하여 혈성, 농양 배액을 30일간 유지한 뒤 제거 후 퇴원하였다. 본 사례는 양측 SCH의 드문 원인으로서 급성 신우신염이 가능함을 확인한 국내 첫 사례 보고라는 점에서 의의가 있다.

Keywords

References

  1. Mao Y, De Oliveira IS, Hedgire S, Prapruttam D, Harisinghani M. Aetiology, imaging features, and evolution of spontaneous perirenal haemorrhage. Clin Radiol 2017;72:175.e19-175.e26. https://doi.org/10.1016/j.crad.2016.08.010
  2. Antonescu O, Duhamel M, Di Giacinto B, Spain J. Spontaneous renal hemorrhage: a case report and clinical protocol. Cureus 2021;13:e15547.
  3. Min JW, Lee SK, Ko YM, et al. Emphysematous pyelonephritis initially presenting as a spontaneous subcapsular hematoma in a diabetic patient. Kidney Res Clin Pract 2014;33:150-153. https://doi.org/10.1016/j.krcp.2014.05.001
  4. Hyun M, Lee JY, Kim HA, Ryu SY. Comparison of Escherichia coli and Klebsiella pneumoniae acute pyelonephritis in Korean patients. Infect Chemother 2019;51:130-141. https://doi.org/10.3947/ic.2019.51.2.130
  5. Bajaj T, Trang N, Nasrawi F, Eppanapally S. A rare case of spontaneous bilateral subcapsular renal hematoma. J Investig Med High Impact Case Rep 2020;8:2324709620918098.
  6. Kim HJ, Kim SW, Jang WY, Kim YS, Park CK. Subcapsular hematoma as a complication of acute pyelonephritis: a case report. J Korean Med Sci 1998;13:551-553. https://doi.org/10.3346/jkms.1998.13.5.551
  7. You CF, Chong CF, Wang TL, Chen CC. Subcapsular renal hematoma complicating acute pyelonephritis. J Emerg Med 2010;39:440-442. https://doi.org/10.1016/j.jemermed.2007.10.042
  8. Choi YS, Park TJ, Tak WT, et al. Two cases of subcapsular renal hematoma as a complication of acute pyelonephritis. Korean J Med 2001;61:669-673.