Escherichia Coli-associated Emphysematous Pyelonephritis in Previously Undiagnosed Type 2 Diabetes Mellitus Requiring Nephrectomy: A Case Report and Review of Literature.

Emphysematous pyelonephritis (EPN) is a rare, life-threatening renal infection that is often associated with diabetes. This report describes a 59-year-old woman with neglected untreated type 2 diabetes who developed EPN caused by Escherichia coli and was complicated by sepsis and acute kidney injury (AKI). Unfortunately, the patient's condition deteriorated despite prompt conservative management with antibiotics, ureteral stenting, and strict glycemic control, as shown by imaging studies. Ultimately, laparoscopic right nephrectomy was performed, resulting in a clinical improvement and recovery. This case indicates that conservative management may fail even in lower-class EPN, particularly when risk factors such as thrombocytopenia and AKI are present.