The initial manifestation of emphysematous pyelonephritis (EPN) with hiccups is extremely rare. We report a 47-year-old diabetic man with complaint of persistent hiccups as the first manifestation. Class 3B EPN was confirmed based on findings of Contrast-enhanced abdominal multi-slice CT scan. There were no neurologic deficits, Medications that lead to hiccups and gastrointestinal dysfunction. Our patient was treated with antimicrobial therapy and double J stenting. His hiccups completely resolved in one week and had no relapse.
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