Emphysematous pyelonephritis: a rare case report


  • Shubhransu Patro Department of Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
  • Pankaj Kumar Khora Department of Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
  • Sukanta Kumar Padhy Department of Urology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India




Diabetes mellitus, Dysuria, Emphysematous, Hyperglycaemia, Pyelonephritis


Emphysematous pyelonephritis (EPN) is a rare and life threatening infection of kidney characterized by gas in the renal parenchyma and surrounding tissues. It occurs mostly in patients with diabetes mellitus and has a predilection for females. It is associated with a high mortality in the absence of rapid and effective treatment; therefore, aggressive medical management, early intervention or surgical approach is recommended. Reported here is a case of a 52-year female with previous medical history of diabetes presented with uncontrolled hyperglycaemia, fever and dysuria with right sided flank pain. She was diagnosed with emphysematous pyelonephritis and successfully treated. As emphysematous pyelonephritis is a life-threatening infection, it should always be considered in the differential diagnosis for a patient with fever with abdominal pain or suspected pyelonephritis particularly in a diabetic.


Kelly HA, MacCallum WG. Pneumaturia. J Am Med Assoc. 1898;31(8):375-81.

Strofilas A, Manouras A, Lagoudianakis EE, Kotzadimitriou A, Pappas A, Chrysikos I, et al. Emphysematous pyelonephritis, a rare cause of pneumoperitoneum: a case report and review of literature. Cases J. 2008;1(1):91.

Mohsin N, Budruddin M, Lala S, Al-Taie S. Emphysematous pyelonephritis: a case report series of four patients with review of literature. Renal Failure. 2009;31(7):597-601.

Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinico-radiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000;160(6):797-805.

Huang JJ, Chen KW, Ruaan MK. Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection. J Urol. 1991;146(1):148-51.

Turney JH. Renal conservation for gas-forming infections. Lancet. 2000;355(9206):770-1.

Vivek V, Panda A, Devasia A. Emphysematous pyelonephritis in a renal transplant recipient- is it possible to salvage the graft? Ann Transplant. 2011;17(3):138-41.

Michaeli J, Mogle P, Perlberg S, Heiman S, Caine M. Emphysematous pyelonephritis. J Urol. 1984;131(2):203-8.

Kim MJ, Park JS, Lim HJ, Jung J, Shin DG, Lee KD et al. Emphysematous pyelonephritis caused by Citrobacter freundii in a patient with type 2 diabetes and neurogenic bladder. Infect Chemotherapy. 2013;45(3):331-4.

Hui L, Tokeshi J. Emphysematous pyelonephritis. Hawaii Med J. 2000;59(8):336-7.

Fatima R, Jha R, Muthukrishnan J, Gude D, Nath V, Shekhar S, et al. Emphysematous pyelonephritis: a single center study. Indian J Nephrol. 2013;23(2):119.

Pontin A, Barnes D. Current management of emphysematous pyelonephritis. Nature Rev Urol. 2009;6(5):272-9.

Somani BK, Nabi G, Thorpe P, Hussey J, Cook J, N’Dow J, et al. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol. 2008;179(5):1844-9.

Karasavidou L, Nikolaou S, Archontakis S, Papatheodorou G, Koroneos V, Drakoulis C. Pyelonephritis emphysematous: Nonsurgical treatment of bilateral emphysematous pyelonephritis in a diabetic patient. J Nephrol. 2006;19:664-7.

Oh YK, Choi YH, Sung CK, Lim CS. Emphysematous pyelonephritis treated with percutaneous catheter drainage and antibiotics. Nephrol Dialysis Transplant. 2006;21(11):3331-2.






Case Reports