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Emphysematous pyelonephritis (EPN) is a severe, necrotising infection of the renal parenchyma and surrounding tissues, most often accompanied by diabetes mellitus and Gram-negative bacilli. Tuberculosis superinfection is very rare, with only a few cases reported in the literature. We present the case of a 61-year-old woman with multiple comorbidities, in whom emphysematous pyelonephritis (EPN) was primarily due to typical bacterial pathogens and subsequently complicated by a superinfection with Mycobacterium tuberculosis, highlighting the importance of recognizing this unusual secondary infection to avoid unnecessary nephrectomy.