A 46-year-old chronic diabetic presents to the emergency with high grade fever and dysuria. Urine analysis reveals multiple leucocytes and glycosuria. CT scan of the abdomen shows the following. What is the most likely diagnosis?

Emphysematous pyelonephritis is the infection of kidneys with characteristic gas formation within or around the kidneys. If not treated early it may lead to sepsis and death. CT shows fluid collections with gas-fluid levels within destructed renal parenchyma. The patient usually presents with fevers and flank pain. In diabetics, who are the ones at risk for this condition, leucocytosis and hyperglycaemia are prominent laboratory findings. The presence of thrombocytopenia is paicularly associated with poor prognosis More common in females 90% of patients have uncontrolled diabetes mellitus. Causative organisms include: A. Escherichia coli: usually considered the commonest causative organism B. Klebsiella pneumonia C. Proteus mirabilis Plain Radiograph shows mottled gas within the renal fossa or crescentic gas collection within Gerota's fascia.