Emphysematous pyelonephritis is a rare disease complicated from diabetes or obstructive uropathy. The characteristic of this disease is the presence of gas within the renal parenchyma, which may enter the perinephric space by extension. It was first reported in 1898 by Kelly and MacCallum. Up to 1992 only about 90 cases have been reported in English literature. In Korea, Shin et al. reported the first case of emphysematous pyelonephritis in 1982, and only about 28 cases reported in the next decade. In most cases, surgical therapies were recommended for emphysematous pyelonephritis. We report on a case of emphysematous pyelonephritis in diabetic patient who had been treated with medical therapy (antibiotics and blood glucose control by open loop insulin pump). Without surgical intervention, the patient (34-year-old female) recovered from emphysematous pyelonephritis.