A 51-year-old woman presented to Hitit University, Çorum Training and Research Hospital, Urology Department, Çorum, Turkey, in October 2014, with air in the urinary tract on ultrasonographic examination. White blood cells levels were 27100 x 106/L (4000-10000), creatinine was 2.82 mg/dL (0.2-1.3), glucose was 88 mg/dL (70-110) and CRP was 185 mg/dL (0-5). Urine culture was positive with Escherichia coli. Computed tomography of the urinary system was consistent with the diagnosis of emphysematous pyelonephritis (Figure 1). Of note, patient had history of rectal cancer which was treated with low anterior resection with hysterectomy, bilateral salpingo-oophorectomy and ureteroneocystostomy, followed by 5-flurouracil and oxaliplatin. Since her operation eight months ago, patient needed intermittent self-catheterization. Emphysematous pyelonephritis is a rare necrotizing bacterial infection of the kidney and has a high mortality rate (23%) [1]. Emphysematous pyelonephritis generally affects adults. It is especially associated with diabetes and urinary tract obstruction. Escherichia coli is the main bacterial agent.