Candidal emphysematous pyelonephritis: A case report on rare and challenging clinical entity

Emphysematous pyelonephritis is a rare, severe acute necrotizing infection characterized by the presence of gas within the renal parenchyma, collecting system, and perirenal tissue. It is an aggressive disease with high morbidity and mortality. Patients have female preponderance and commonly have uncontrolled diabetes. It is caused most commonly by Escherichia coli and very rarely by Candida species. Unlike others, candidal emphysematous pyelonephritis has an indistinctive presentation and diagnosed late, thus delaying prompt treatment.

A 35-year-old Type 2 diabetic woman developed pyelonephritis. Computerized tomography revealed the gas in the renal parenchyma, establishing the diagnosis. Cultures isolated Candida albicans as a causative organism. The patient was treated successfully with nephrectomy as initial medical therapy and percutaneous nephrostomy failed.

Rare causative agent should be suspected if clinical presentation is indistinctive and conservative management fails. Nephrectomy is still preferred in such patients.