Emphysematous Pyelonephritis Involving Native Kidneys and a Transplanted Kidney

Emphysematous pyelonephritis (EPN) is an acute severe necrotizing form of UTI, with air collection in the renal parenchyma, collecting system, and surrounding tissues. Most common causative organisms are Escherichia coli and Klebsiella. Here we present a 71-year-old Caucasian male with multiple medical problems who was transferred to our ER from a long-term acute care hospital (LTACH) for hematuria, UTI, and septic shock. He is a recipient of a deceased donor renal transplant and was receiving IV amphotericin B for recent cryptococcal meningitis. CT abdomen showed bilateral EPN, including the transplanted kidney. He received aggressive fluid resuscitation, vasopressors, and IV antibiotics and got admitted to the ICU. Unfortunately, his clinical course worsened and required ventilatory support, and his family opted for comfort care because of the high mortality rate. The emphasis of this case report is to investigate immunocompromised patients presenting with UTIs for EPN.