Emphysematous pyelonephritis: The silent March to mycotic aortic aneurysm— A catastrophic vascular complication in a diabetic patient

Emphysematous pyelonephritis (EPN) complicated by mycotic aortic aneurysm remains exceptionally rare; only one prior case exists in the literature (1993). We describe the second — a middle-aged diabetic male with EPN Class I/II and obstructive urolithiasis who improved following ureteral stenting and antibiotics. Two months later, CT aortogram showed complete resolution of renal gas but new peri-aortic inflammation and a saccular mycotic aneurysm at L3, confirming insidious vascular seeding despite apparent urological recovery. Extensive iliofemoral venous thrombosis was noted. The patient succumbed despite maximal management. This case highlights vigilance for vascular complications in diabetic EPN patients with aortic calcification , DVT.