Emphysematous Pyelonephritis as Epididymo-Orchitis—a Rare Presentation

Scrotal swelling, extending to the inguinal region along with pain and fever suggests infection. The cause is usually epididymo-orchitis often secondary to urinary tract infection and can be complicated by diabetes mellitus. The other causes of such presentation include strangulated inguinal hernia, abscess tracking from the iliac region from appendix or diverticulitis. Extensive emphysematous pyelonephritis (EPN) spreads to perinephric and paranephric spaces. EPN can rarely track up to the inguinal canal and scrotum. We report a rare presentation of EPN mimicking left epididymo-orchitis in a 65-year-old male with uncontrolled sugars. Computed tomography of the abdomen showed left-sided EPN, spreading to the perinephric, paranephric, and paraaortic, coming down up to left inguinal region and scrotum. He responded to culture-sensitive antibiotics and percutaneous drainage.