My flanks aches: Emphysematous pyelonephritis in a newly diagnosed case of diabetes mellitus

Emphysematous pyelonephritis (EPN) is a rare, severe necrotising infection of the renal parenchyma and surrounding tissues. It is usually life-threatening and should be promptly treated. Here, we report a clinical case of a 54-year-old male who presented with the left flank pains of 3-week duration. The flank pain was described as dull, constant with associated fever. He was diagnosed with diabetes mellitus (DM) while on admission. A clinical diagnosis of the left pyelonephritis was made. The abdominopelvic computed tomography scan confirmed bilateral EPN by showing a thin film of perinephric fluid (13.2 ml) in the left lower pole. He was managed conservatively with fluid therapy, adequate glycaemic control and intravenous antibiotics with no percutaneous drainage done. This highlights the importance of early initiation of appropriate medical treatment to avoid interventional urological procedures of nephrectomy. It also highlights the importance of clinical suspicion of EPN in patients presenting with symptoms of urinary tract infection and DM.