# The Disappearing Act: A Case of Emphysematous Pyelonephritis and a Vanishing Kidney Allograft

## TL;DR

A kidney transplant recipient developed a severe kidney infection with gas accumulation, leading to loss of the transplanted kidney.

## Contribution

A rare case of emphysematous pyelonephritis in a kidney allograft is reported, highlighting its rapid progression and management challenges.

## Key findings

- Emphysematous pyelonephritis in renal allografts is rare but can lead to graft loss.
- Early detection and timely intervention are critical for managing this condition.
- Transplant recipients may be at risk despite their immunosuppressed state.

## Abstract

Emphysematous pyelonephritis is an acute, severe infection of the kidneys with gas accumulation in the kidneys and adjacent tissues, which is associated with significant morbidity and mortality. Primarily seen in native kidneys, it is relatively rare in renal allograft, despite the immunosuppressed state of transplant recipients and is associated with a high risk of graft loss. Risk factors include urinary tract abnormalities, urological procedures, diabetes mellitus, female gender, and the postmenopausal state. We report a transplant recipient with rapid progression of acute pyelonephritis to emphysematous pyelonephritis and eventually required a transplant nephrectomy. Management is geared towards early detection, judicious antibiotic therapy, repeat imaging, and timely intervention.