Emphysematous Pyelonephritis at 29 Weeks of Gestation: A Case Report and Review of the Literature.

Emphysematous pyelonephritis (EPN) is a urinary tract infection progression characterized by gas retention in the renal tissues and a high mortality rate, but few cases have been reported. In this study, we present a 32-year-old primigravida with type 2 diabetes mellitus and a history of pyelonephritis who developed pyelonephritis at 29 weeks. Antimicrobial therapy was initiated; however, her clinical symptoms worsened. Ultrasonography and magnetic resonance imaging (MRI) led to a diagnosis of EPN. Fortunately, the patient improved with antibiotic therapy and delivered at 39 weeks.  Treatment for EPN may require invasive procedures such as percutaneous drainage or nephrectomy. Early diagnosis and timely intervention are crucial for the management of EPN during pregnancy. This case report highlights the need for imaging evaluation and tailored treatment strategies to balance maternal and fetal health in the treatment of EPN during pregnancy.