The Disappearing Act: A Case of Emphysematous Pyelonephritis and a Vanishing Kidney Allograft

Emphysematous pyelonephritis is an acute, severe infection of the kidneys with gas accumulation in the kidneys and adjacent tissues, which is associated with significant morbidity and mortality. Primarily seen in native kidneys, it is relatively rare in renal allograft, despite the immunosuppressed state of transplant recipients and is associated with a high risk of graft loss. Risk factors include urinary tract abnormalities, urological procedures, diabetes mellitus, female gender, and the postmenopausal state. We report a transplant recipient with rapid progression of acute pyelonephritis to emphysematous pyelonephritis and eventually required a transplant nephrectomy. Management is geared towards early detection, judicious antibiotic therapy, repeat imaging, and timely intervention.