Fever with abdominal pain and diabetes - Is it Emphysematous Pyelonephritis?

Emphysematous pyelonephritis (EPN) is a rare, severe infection of renal parenchyma presenting commonly with fever and flank pain and presence of gas in the renal and/or peri-renal space. EPN can be life threatening if not diagnosed and treated promptly. Air shadows in the renal or peri-renal region on imaging studies of the abdomen are diagnostic features of EPN. However, computed tomography (CT) scan of the abdomen is better than ultrasound for diagnostic classification, prognosis, and treatment options. We treated a young female with uncontrolled type II diabetes mellitus who had severe abdominal and back pain with fever. The CT scan confirmed the diagnosis of EPN. The conservative treatment itself was effective in complete resolution of the disease even though patient had severe type of EPN.