Ahmed Daoud, Amira Elbendary, Mohanad Elfishawi, Mahmoud Rabea and Mostafa Alfishawy
Emphysematous pyelonephritis is an acute necrotizing renal and perirenal infection, caused by gas forming organism. Mucormycosis is an opportunistic aggressive fungal infection causing tissue thrombosis and necrosis. Erythema nodosum leprosum reaction is an inflammatory reaction occurring in borderline and lepromatous leprosy before, during or after multidrug treatment, where immune complexes deposit in various organs resulting in considerable damage to the organs that were site of deposition. Both emphysematous pyelonephritis and mucormycosis are infections that occur principally in diabetics, especially with poor control of blood sugar. Herein we report a 27 year old woman presenting to the emergency department with diabetic ketoacidosis as a first presentation of diabetes, where array of investigations revealed emphysematous pyelonephritis, palatal mucormycosis, and erythema nodosum leprosum. The early aggressive management with the correction of blood glucose and ketoacidosis help to give a successful outcome to the patient. To the best of our knowledge, this case is the first in English literature to report coexisting bilateral emphysematous pyelonephritis and palatal mucormycosis in a diabetic patient, precipitating erythema nodosum leprosum, and highlights the possibility of occurrence of more than one serious condition in a diabetic at a time.