DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.050

Pages: 2640-2643

Background: Emphysematous pyelonephritis (EPN) is a rare, severe necrotizing infection of the renal parenchyma and surrounding tissues characterized by gas production by uropathogenic bacteria, most commonly Escherichia coli. It is associated with high morbidity and mortality, particularly in patients with uncontrolled diabetes mellitus. Bilateral involvement is extremely rare and carries a particularly poor prognosis if not managed promptly and appropriately. EPN often requires early identification with imaging such as computed tomography (CT), which remains the gold standard for diagnosis. CT based classification systems have been used to stratify severity and guide management. Early aggressive therapy combining antibiotics with drainage or surgical intervention improves outcomes. Case Presentation: We present the case of a 24 year old patient with chronic kidney disease who presented with acute onset of bilateral flank pain, fever, and systemic signs of infection. Laboratory investigations revealed leukocytosis and acute kidney injury. CT scan demonstrated extensive gas formation in both kidneys consistent with bilateral emphysematous pyelonephritis. Conclusion: Bilateral EPN is an uncommon but life threatening condition. Early diagnosis based on imaging, rapid initiation of appropriate antimicrobial therapy, and timely intervention, such as drainage or nephrectomy when indicated, are critical to improving survival and preserving renal function. This case highlights the importance of integrating clinical, radiological, and microbiological data for optimal management of bilateral EPN.