Emphysematous Pyelonephritis in a Non-Diabetic Renal Transplant Patient: A Rare Encounter

Introduction: Emphysematous pyelonephritis is a necrotizing infection characterized by the presence of gas in the renal parenchyma, collecting system, and peri-renal tissues. It is a life-threatening disease with a nonspecific presentation and is extremely rare in transplant recipients. Associated factors include diabetes mellitus, female sex, immunosuppression, urinary tract obstruction, and impaired vascular supply.Case Presentation: We present a case of a non-diabetic male who underwent a kidney transplant earlier and later exhibited fever, nausea, and flank discomfort. The presence of gas was confirmed through computed tomography, and the patient was therapeutically managed with percutaneous drainage, broad-spectrum antibiotics, and intense hydration. A graft biopsy performed 40 days post-transplant showed no findings suggestive of rejection. Enhanced outcomes were observed due to early diagnosis and a multidisciplinary care approach, ultimately allowing the patient to continue with successful kidney transplantation.Conclusions: This case emphasizes the contemporary tomographic criteria used in diagnosing and treating emphysematous pyelonephritis. It also underscores the importance of considering the patient's clinical status when determining the necessity of nephrectomy in cases of emphysematous pyelonephritis.