Emphysematous pyelonephritis with IVC thrombus in new onset diabetes mellitus

Emphysematous pyelonephritis (EPN) is a rapidly progressive necrotizing infection characterized by gas in the kidneys. We describe a 48-year-old woman, a newly diagnosed diabetic, who presented with clinical features of right sided pyelonephritis with hematuria of short duration. On further evaluation, she was diagnosed to have right sided EPN, with thrombus in the renal vein and inferior vena cava (IVC). She was managed conservatively with hydration, insulin, intravenous antibiotics, anticoagulants and ureteric stenting on the right side. On follow-up, the gas shadows resolved and the thrombus completely regressed.