Severe emphysematous pyelonephritis on a horseshoe kidney

Emphysematous pyelonephritis is an acute bacterial infection responsible for a high mortality. It is characterized by bacterial gas production in the renal parenchyma, occurring in diabetic patients in most case. The gold standard treatment has always been surgery associated with antibiotic therapy. We report the case of a 58 year-old woman, with undocumented diabetes, who presented with emphysematous pyelonephritis complicated with septic shock and acute renal failure. Antibiotherapy alone was successful.