ABSTRACT
We report a 53 years old Saudi man a known diabetic for more than 15 years. He presented with lower abdominal pain, diarrhea and vomiting. He had symptoms and signs of sepsis. He had pancytopenia, renal failure, and his blood culture grew E.Coli. He remained febrile despite antibiotics administration for one week and developed crepitation over both thighs. Radiologically, plain-x ray, ultrasound and CT scan of the abdomen confirmed the presence of air in the left kidney involving the renal parenchyma and the collecting system and extensive gas in subcutaneous tissue of the thighs with abscesses. Repeated surgical drainage of the renal and the extra renal abscesses helped the antibiotic that was continued for several weeks to control the infection. Emphysematous pyelonephritis is a rare but life threatening condition that can be difficult to treat especially if the gas forming organism extends outside the kidney.
