A 39-year-old male patient presented with fever, left flank pain, nocturia, and daytime frequency. He was on intensive phase of antitubercular therapy for pulmonary tuberculosis. The left flank was tender on examination. Urine microscopy showed pyuria and hematuria. The serum creatinine was 1.82 mg%. Ultrasound showed a bulky left kidney with moderate hydroureteronephrosis. A left percutaneous nephrostomy was placed. He became afebrile and serum creatinine normalized after 48 h. The nephrostogram obtained subsequently showed central pooling of contrast in the excavated area [Figure 1, white arrow] in the region of interpole papilla giving "egg-in-a-cup" appearance characteristic of papillary necrosis [Figure 1].