Emphysematous pyelonephritis in a pelvic ectopic kidney: A rare case report

Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing renal infection characterized by gas formation within the renal parenchyma, collecting system, or perirenal tissues. Its occurrence in a pelvic ectopic kidney is exceptionally uncommon. We report the case of a 56-year-old man with poorly controlled type 2 diabetes mellitus who presented with fever, pelvic pain, and septic shock. Computed tomography (CT) demonstrated a left pelvic ectopic kidney with multiple renal calculi and an obstructing ureteral calculus, with gas confined to the collecting system, consistent with Huang and Tseng Class I EPN. Despite emergency management, the patient developed refractory septic shock with multiorgan failure and died 2 days after admission. This case highlights the exceptional association of EPN with a pelvic ectopic kidney and the pivotal role of CT in identifying the anatomical anomaly, classifying disease severity, detecting obstructive urolithiasis, and guiding therapeutic management.