Spot Diagnosis of Gas-Forming Pyelonephritis in a Diabetic Woman: Underscoring the Value of Timely Radiological Evaluation

Abstract

Background: Emphysematous pyelonephritis (EPN) is a fulminant, necrotizing, gas-forming infection of the kidney, encountered predominantly in diabetic patients and associated with high mortality when diagnosis is delayed. Case Presentation: A 45-year-old woman with Type-II Diabetes Mellitus presented with five days of fever and left flank pain. A kidney, ureter, and bladder (KUB) radiograph demonstrated gas in the region of the left kidney. Subsequent CT of the kidneys and urinary bladder revealed destruction of more than one-third of the renal parenchyma with a mottled gas pattern, consistent with EPN. The disease was categorized as Type II emphysematous pyelonephritis and classified as Huang–Tseng Class 3b, showing gas within the renal parenchyma and extension into the pararenal space. Management and Outcome: The patient was treated with prompt CT imaging-based diagnosis, aggressive intravenous antibiotic therapy, and appropriate urological intervention, which led to clinical improvement and renal preservation. Conclusion: This case underscores the critical importance of early imaging in diabetic patients with suspected pyelonephritis. Timely radiologic evaluation enables accurate classification, guides appropriate management, and improves outcomes in emphysematous pyelonephritis.