# Emphysematous Pyelonephritis Revealing Underlying Renal Tuberculosis: A Rare and Challenging Association

## TL;DR

A rare case of emphysematous pyelonephritis complicated by tuberculosis is reported, emphasizing the need for accurate diagnosis to prevent unnecessary surgery.

## Contribution

This case highlights the rare association of tuberculosis with emphysematous pyelonephritis.

## Key findings

- EPN was initially caused by typical bacterial pathogens.
- A superinfection with Mycobacterium tuberculosis occurred.
- Early recognition of tuberculosis is crucial to avoid unnecessary nephrectomy.

## Abstract

Emphysematous pyelonephritis (EPN) is a severe, necrotising infection of the renal parenchyma and surrounding tissues, most often accompanied by diabetes mellitus and Gram-negative bacilli. Tuberculosis superinfection is very rare, with only a few cases reported in the literature.

We present the case of a 61-year-old woman with multiple comorbidities, in whom emphysematous pyelonephritis (EPN) was primarily due to typical bacterial pathogens and subsequently complicated by a superinfection with Mycobacterium tuberculosis, highlighting the importance of recognizing this unusual secondary infection to avoid unnecessary nephrectomy.