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+Female patient, 62 years old, poorly controlled diabetic, obese, with a history of unresolved left chorioriform lithiasis. She consulted for fever and left lumbalgia of 7 days' evolution, with oral mycosis and frank deterioration of general condition. She presented leukocytosis with marked neutrophilia, hyperglycaemia with ketoacidosis and elevated urea and creatinine levels. Physical examination revealed a soft abdomen, with pain in the left flank and positive left renal percussion. Abdominal ultrasound and direct abdominal X-ray were performed, which led to the diagnosis by identifying air in the left renal fossa. Abdominal and pelvic CT scan showed air in the left kidney and perirenal tissues, which infiltrated the abdominal wall. Due to the rapid deterioration of his general condition, drainage of the renal fossa was performed by lumbotomy to avoid contamination of the peritoneal cavity, evacuating the gas and debriding necrotic tissue. After an initial improvement, signs of sepsis reappeared and simple nephrectomy was performed a week later. Good postoperative evolution, 14 days later new sepsis of respiratory origin. He started with purulent secretion through the wound, a toilette was performed, but he died 48 hours later due to multiple organ dysfunction with nosocomial pneumonia.
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