Background: Emphysematous pyelonephritis (EPN) is a rare but potentially devastating complication after renal transplantation. It carries the risk of graft loss and is associated with a high mortality. The majority of cases reported thus far have undergone graft nephrectomy.
Case Report: We report the case of a live-related renal transplant recipient who presented 10 years later with fever, graft tenderness and worsening serum creatinine. Computed tomography (CT) revealed emphysematous pyelonephritis, with a large perinephric collection. The case was managed successfully by percutaneous drainage.
Conclusions: Percutaneous drainage is a safe and effective therapeutic modality in cases of EPN in transplant recipients, and allows salvage of the renal allograft in most cases.

Keywords: emphysematous pyelonephritis, transplant, percutaneous drainage