Emphysematous pyelonephritis in a diabetic patient: A case report highlighting diagnostic challenges and successful conservative management

Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing renal infection predominantly affecting diabetics. We report a 66-year-old female with uncontrolled type 2 diabetes who presented with right flank pain and fever. CT confirmed Class 2 EPN with gas confined to the renal parenchyma. Blood cultures grew Escherichia coli . She was successfully managed conservatively with imipenem-cilastatin, fluid resuscitation, and insulin therapy, avoiding surgery. This case highlights CT's role in early EPN diagnosis and demonstrates that tailored medical management can be a nephron-sparing alternative in selected patients.