以急性腰痛表現之產氣性泌尿道感染

Emphysematous Urinary Tract Infection Presenting as Acute Lower Back Pain: A Case Report

產氣性泌尿感染屬於暴發、劇烈性的嚴重感染症。本案例是一位76歲男性病人，因突發性腰痛就診，初步因尿管阻塞導致急性尿滯留，經腹部X光、電腦斷層結果為產氣性腎盂炎及膀胱炎，於施行膀胱鏡及膀胱造廔手術後，經歷敗血性休克併高碳酸血症呼吸衰竭及急性腎損傷，最後多重器官衰竭死亡。針對此類以產氣性泌尿道感染的多重危險因子（如糖尿病、神經源性膀胱、反覆泌尿道感染等）、泌尿道感染合併尿中帶有空氣的病人時，必須將產氣性腎盂腎炎或膀胱炎列為鑑別診斷，以免錯失治療先機、引發致命風險。

Emphysematous urinary tract infections (EUTIs) are severe infections characterized by a rapid onset and aggressive progression. This case involves a 76-year-old male patient who sought medical attention for sudden-onset lower back pain. Initial assessment suggested acute urinary retention caused by urethral obstruction. Abdominal X-ray and computed tomography (CT) examination results indicated emphysematous pyelonephritis and cystitis. Following cystoscopy and cystostomy, the patient developed septic shock complicated by hypercapnic respiratory failure and acute kidney injury, ultimately resulting in death due to multiple organ failure. In patients with multiple risk factors for EUTI (e.g., diabetes mellitus, neurogenic bladder, recurrent UTIs) or with a UTI complicated by pneumaturia, emphysematous pyelonephritis and cystitis should be included in the differential diagnosis to avoid missing early treatment opportunities and triggering fatal risks.