A woman in her early eighties, with well controlled diabetes (HbA1c 6.1%), heart failure and Parkinson´s disease, was admitted to our hospital due to global respiratory failure. On the second day of hospitalization, a refractory fever appeared; she was otherwise asymptomatic and her laboratory data was unremarkable, including urinalysis. Klebsiella pneumoniae was isolated in urinary culture after three negative samples and four negative blood cultures. A computed tomography revealed air within the bladder wall (Fig. 1), suggestive of emphysematous cystitis. The patient was treated conservatively with broad spectrum antibiotics and urinary catheterisation but, unfortunately, she did not survive. Emphysematous cystitis is a rare form of complicated urinary tract infection, more commonly seen in patients with poorly controlled diabetesor other immunosuppressive diseases.^1,2 This uncommon clinical entity is potentially life-threatening;^1,2 thus prompt diagnostic and therapy is mandatory. As shown, diagnosis can be challenging when the patient is asymptomatic.

Figura I

CT scan showing the well-defined bladder, with air within the wall (asterisks); (A) Coronal plane; (B) Transverse plane.

Figura I

CT scan showing the well-defined bladder, with air within the wall (asterisks); (A) Coronal plane; (B) Transverse plane.

  BIBLIOGRAFIA  

1. Mokabberi R, Ravakhah K. Emphysematous urinary tract infections: diagnosis, treatment and survival (case review series). Am. J. Med. Sci. 2007; 333: 111–6.

2. Grupper M, Kravtsov A, Potasman I. Emphysematous cystitis: illustrative case report and review of the literature. Medicine 2007; 86: 47–53.