Emphysematous pyelonephritis is a necrotizing renal infections characterized by intrarenal and occasional perirenal gas production. Although uncommon (89 cases in the literature), it occurs almost exclusively in diabetic patients (87% of the cases). Prompt and aggressive management is required to salvage these patients. We describe a recent case of a diabetic woman with emphysematous pyelonephritis due to E. Coli, successfully managed with unilateral nephrectomy.