Emphysematous pyelonephritis in a patient infected with the human immunodeficiency virus.

Emphysematous pyelonephritis (EPN) is a rapidly progressive and life-threatening infection that is seen most commonly in persons with diabetes. The infecting organisms usually consist of mixed flora, including Escherichia coli (68%), Klebsiella pneumoniae (9%) and Proteus mirabilis. Females are affected twice as often as men, and mortality rates can be as high as 80%. Obstructive uropathy, urinary calculi, calyceal stenosis and neoplasms are significant predisposing factors. We report a case of EPN in a patient with the human immunodeficiency virus infection, without diabetes mellitus or urinary tract obstruction, which responded remarkably to conservative management with antibiotics alone.