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Emphysematous pyelonephritis (EPN) is an acute infection of the kidney, characterized by the presence of gas in the renal parenchyma and collecting system. Conservative management is rarely effective to treat this severe infection and the accepted treatment consists of early nephrectomy. Herein, we report a case of EPN in a horseshoe kidney, presented in a 67-year-old, diabetic woman. A percutaneous drainage of the kidney, under computed tomography control, was realized in emergency to manage her sepsis. A pelvic ureteral calculus was found to be responsible for the urinary obstruction and the infection. It was extracted endoscopically, three weeks later and the evolution was uneventful.