Emphysematous pyelonephritis (EPN) is an acute, rare, inflammatory disease, which typically occurs in patients who suffer from diabetes mellitus. We report the case of a patient who was admitted to the Department of Urology with septic signs, in whom, after performing computed tomography, the diagnosis of EPN was established. The patient underwent organ-preserving treatment, which consisted of pyelolithotomy with nephrostomy, and the insertion of a double J catheter into the left ureter. The importance of the classification of EPN is also discussed. The need for individualized procedures is highlighted.