BEYOND THE USUAL SUSPECTS: A RARE CASE OF DKA COMPLICATED BY EMPHYSEMATOUS PYELONEPHRITIS AND GASTRIC MUCORMYCOSIS

Abstract

A 55-year-old woman with poorly controlled type 2 diabetes mellitus presented with dyspnea, fever, abdominal pain, and was diagnosed with diabetic ketoacidosis (DKA) and acute kidney injury (AKI). Imaging revealed emphysematous pyelonephritis (EPN) with gas-forming destruction of the left kidney, while upper gastrointestinal endoscopy and biopsy confirmed Helicobacter pylori-associated chronic gastritis complicated by invasive gastric mucormycosis. Urine culture grew Candida albicans and endotracheal aspirate yielded Acinetobacter, highlighting polymicrobial infection. This constellation of EPN, DKA, and gastric mucormycosis is exceedingly rare and underscores the need for high clinical suspicion in diabetic patients with multiorgan symptoms. The patient was managed with insulin infusion, DJ stenting, broad-spectrum antibiotics, and liposomal amphotericin B, but was discharged against medical advice. This case emphasizes the diagnostic and therapeutic challenges posed by simultaneous renal and gastric fungal infections in an immunocompromised host and contributes unique insight to the limited literature on such presentations