Concurrence of emphysematous pyelonephritis related to renal tuberculosis and iliopsoas abscess is exceedingly rare, and its coexistence with COVID-19 pneumonia presented as "diabetic ketoacidosis" may have fatal consequences. A 46-year-old diabetic female patient was manifesting signs of septic shock; unconsciousness, febrile episodes, tachycardia and tachypneia when she was first admitted to our emergency department. She had positive real-time PCR test results for COVID-19 four days before her admission with symptoms of abdominal pain, fever, nausea, weakness, chest tightness, and shortness of breath persisting for a week. Blood test results were consistent with diabetic keto acidosis. Computed tomography (CT) showed left-sided emphysematous pyelonephritis and iliopsoas abscess. The patient was managed using percutaneous drainage and empirical antibiotics. Besides, renal tuberculosis was identified in the patient who did not respond to the treatment offered. A poor glycemic control may cause various fatal clinical complications. Concurrence of emphysematous pyelonephritis and iliopsoas abscess may be devastating for the patient that must be promptly managed to avoid any occurrence of septic shock. As the response to the treatment offered was inadequate, the coexistence of other disease states as renal tuberculosis was contemplated.

Keywords : emphysematous pyelonephritis, renal tuberculosis, iliopsoas abscess, COVID-19 pneumonia, diabetic ketoacidosis