Extensive emphysematous urinary tract infection involving the renal pelvis, ureter, and bladder successfully treated with ureteral stenting

Simultaneous involvement of the renal pelvis, ureter, and bladder in emphysematous urinary tract infections is rare. A 79-year-old woman presented with fever, septic shock, disseminated intravascular coagulation, and acute kidney injury. Computed tomography revealed intraluminal gas involving these three structures/organs, with hydronephrosis. Her serum procalcitonin levels were high (388.90 ng/mL). Ureteral stenting and antimicrobial therapy were initiated, resulting in clinical improvement. Three-dimensional reconstruction enabled visualization of the gas distribution and resolution after treatment. The emphysematous lesions had disappeared by day 15. This case highlights the importance of early urinary drainage and appropriate antimicrobial therapy in extensive emphysematous urinary tract infections.