Candida Albicans and Escherichia Coli Superinfection in Emphysematous Pyelonephritis: A Case Report of A Challenging Presentation and Management.

Emphysematous pyelonephritis is a rare, life-threatening infection of the kidney characterized by necrosis and gas formation within the renal parenchyma, collecting system, and perinephric tissue. It commonly occurs in patients with poorly controlled type 2 diabetes mellitus (T2DM) and in those with obstructive nephropathy. The most frequent causative pathogen is Escherichia coli, while Candida albicans is rarely implicated. This condition carries a high fatality rate, and early, aggressive medical interventions are recommended. We report a 66-year-old female with uncontrolled T2DM who presented with constitutional symptoms and abdominal pain, clinically suggestive of diabetic ketoacidosis with urinary tract infection (UTI). Urine culture revealed Candida albicans, and abdominal computed tomography (CT) revealed gas within the renal parenchyma, confirming the diagnosis of EPN. The patient initially responded well to medical therapy; however, she subsequently developed complications a few days after discharge, ultimately leading to her demise. Emphysematous pyelonephritis is a life-threatening condition, and sequential microbial (fungal-bacterial) infection underscores its unpredictable clinical course, even after initial improvement. The challenges are further magnified in settings with limited access to advanced diagnostic and interventional resources. Sustained vigilance, along with timely and aggressive multidisciplinary management during the post-acute phase, remains essential to prevent catastrophic outcomes.