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A case of papillary renal cell carcinoma complicated with emphysematous pyelonephritis is reported. A 75-year-old woman with diabetes mellitus was admitted to our hospital with macroscopic hematuria and a child's head-sized firm mass in the left hypochondrium. Computed tomographic (CT) scanning revealed a huge left renal tumor with hydronephrosis. The patient had acute pyelonephritis and antibacterial therapy was initiated. Ten days later, conservative therapy was not effective and CT scan revealed emphysematous necrotic tissue in the tumor. We performed percutaneous drainage. Then dark red liquid and gas were discharged. Her general condition was improving. Left radical nephrectomy was performed. The mass was solid and pathological diagnosis was papillary renal cell carcinoma with necrotic tissue and coated by a thick pseudocapsule. She has remained free of disease for 27 months after operation.