Bilateral Emphysematous Pyelonephritis in a Retroviral Disease Patient.

Emphysematous pyelonephritis (EPN) is a rare infection characterized by the presence of gas in the renal parenchyma and surrounding tissues. This condition is frequently seen in individuals with diabetes and is rarely observed in patients with human immunodeficiency virus (HIV) infection. A 41-year-old retroviral disease (RVD)-positive female patient on highly active antiretroviral therapy (HAART) presented with features of pyelonephritis. An abdominopelvic non-contrast CT scan revealed gas within the renal parenchyma and collecting systems of both kidneys, establishing the diagnosis of EPN. The patient was treated successfully with oral levofloxacin, which upon a repeat CT showed clearance of the gas pockets. Emphysematous pyelonephritis is a rare but potentially life-threatening infection of the kidney, commonly occurring in diabetics and rarely found in HIV patients. In selected cases, this condition can be treated effectively on an outpatient basis with oral antibiotics alone.