Background: Severe sepsis in elderly is a serious problem. Elderlies are more vulnerable to sepsis than adults due to their hypoimmunity, coagulation abnormalities and organ dysfunction. Acute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes severe sepsis and septic shock. Acute obstructive pyelonephritis sometimes requires emergency drainage via a ureteral stent or percutaneous nephrostomy. Acupuncture has been proved as an alternative method for renal colic pain control and maybe a potential organ protection function in sepsis. Case report: We report a case of a 104-year-old female centenarian with severe sepsis induced by acute obstructive pyelonephritis. The initial clinical manifestation in the case was atypical, which was misdiagnosed as acute heart failure and pneumonia. The centenarian underwent percutaneous nephrostomy, electro-acupuncture treatment, anti-infective therapy and mechanical ventilation. The patient was achieved successful treatment and discharged from hospital with no sequel. Conclusions: To date, no clinical case report of this nature has been described implicating centenarian with severe sepsis induced by APN. Patient hiding illness state made diagnosis more difficult. The effect of combination traditional Chinese and western medicine was satisfactory, experience was worth reference to improve the diagnosis and treatment of severe sepsis in elderly patients.