Gas-containing renal matrix stones in a patient with emphysematous pyelitis treated with delayed percutaneous nephrolithotomy

Background: The presence of intra-calcular gas might indicate the coexistence of gas-forming bacterial infections, which are potentially severe and life threatening. Gas-containing renal stones are rare. Herein, we present a case of gas-containing renal matrix stone that was associated with emphysematous pyelitis and reflect on its management. Case Presentation: A 30-year-old woman, with no underlying comorbidities, presented at 30 weeks of pregnancy with symptoms of pyelonephritis. Imaging showed no renal stones. Postdelivery, she presented again with similar symptoms in addition to pneumaturia. Imaging showed several large gas-containing renal matrix stones associated with emphysematous pyelitis, pneumoureter, and pneumobladder. She improved with oral antibiotics and underwent percutaneous nephrolithotomy 6 weeks later. Conclusion: The presence of intra-calcular gas does not necessarily indicate a serious condition and the treatment can be planned according to the patient’s symptoms and the presence and type of any emphysematous renal infection.