A 40-year-old woman with diabetes mellitus was admitted to our hospital for a high fever and left back pain. She was initially diagnosed with acute pyelonephritis by laboratory data and started with intravenous antibiotics. However, her general condition worsened. Computed tomography (CT) showed a gas shadow within the left renal parenchyma and we made a diagnosis of emphysematous pyelonephritis. Percutaneous drainage guided by CT was performed immediately. She recovered and was discharged. Cultures of the pus grew Escherichia coli. We review previous cases of emphysematous pyelonephritis reported in Japan, and discuss the etiology, treatment and prognosis of such cases.

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