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Emphysematous pyelonephritis (EPN) is an uncommon but necrotizing renal infection due to gas-forming coliform bacteria that usually occurs in patients with diabetes mellitus and/or obstructive uropathy. Bilateral EPN is rarely seen and recurrent infection in different kidneys has never been reported in the literature. Here we present a female diabetic patient who experienced two episodes of EPN in different kidneys within 2.5 years, resulting in death eventually. We discuss the pathogenesis, incompatibility between clinical features and radiological findings of EPN, and the principle of management for this life-threatening infection.
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