en Surgery Surgery case report case report <span style="font-size:14px;"><span style="font-family:Times New Roman;"><span style="color:#0000ff;"><strong><em>Background</em></strong><em>:</em></span> Xanthogranulomatous pyelonephritis (XGP) is a rare and intense type of chronic kidney infection characterized by subversion of the renal tissue and its replacement by lipid- laden macrophages. XGP combined with emphysematous pyelonephritis (EPN) is rare and up until now only 7 cases with these&nbsp; presentations have been reported; so abundant clinical skills and appropriate&nbsp; radiographic imaging&nbsp; is required to reach the correct diagnosis. In this report, we present a case with two uncommon variants of pyelonephritis.<br> <span style="color:#0000ff;"><strong><em>Case Presentation</em></strong><em>:</em> </span>A 55-year-old female presented with a history of&nbsp; type 2 diabetes mellitus, and a stroke leading to a left-sided hemiplegia state for 7 years, coronary artery bypass grafting (CABG), hypertension (HTN), seizure, progressive fatigue, loss of appetite , fecal and urinary incontinence and right costovertebral angle tenderness. According to clinical signs, symptoms and documentation of gas within the renal parenchyma on computed tomography (CT) of abdomen, of EPN diagnosis was suggested; however histopathologic evaluation showed acute emphysematous pyelonephritis on chronic xanthogranulomatous pyelonephritis.<br> <span style="color:#0000ff;"><strong><em>Conclusion</em></strong><em>:</em></span> EPN can emerge in a patient suffering from XPG which would add to the severity of the situation. In the case presented, concurrent underlying diseases such as diabetes mellitus, stroke, CABG, HTN along with severe fatigue and loss of appetite existed. Surgical treatment produces dramatic results.</span></span> Xanthogranulomatous pyelonephritis, emphysematous pyelonephritis, Staghorn calculi 505 508 http://caspjim.com/browse.php?a_code=A-10-151-2&slc_lang=en&sid=1 Emadoddin Moudi emadmoudi@gmail.com 100319475328460031492 100319475328460031492 No Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Mohammadmehdi Darzi emadmoudi@gmail.com 100319475328460031493 100319475328460031493 No Department of Urology, Babol University of Medical Sciences, Babol, Iran Sepehr Ramzani sepehr.ramezany74@gmail.com 100319475328460031494 100319475328460031494 No Student Research Committee, Babol University of Medical Sciences, Babol, Iran Abazar Akbarzadehpasha Aapasha812@yahoo.com 100319475328460031495 100319475328460031495 Yes Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran