We present a case of 75-year-old man with type 2 diabetes and emphysematous pyelonephritis (EPN). The patient presented with abdominal pain, fever of undetermined origin and progressive decrease in urine output. Computerized tomography scan revealed gas formation in the left renal parenchyma and capsule. A left nephrectomy was performed. He made a quick recovery. EPN should be taken into consideration in diabetic patients with symptoms of pyelonephritis who show a poor response to conventional treatment. Elective nephrectomy may be life saving in some patients.