Emphysematous Cystitis.

A 68-year-old Japanese woman with a history of diabetes mellitus, hypertension, chronic kidney disease (also called chronic kidney failure), and coronary artery disease presented to our emergency department with a one-day history of nausea and vomiting. Blood tests showed leukocytosis and hyperglycemia. A urinary analysis revealed pyuria and bacteriuria. After admission, sepsis developed and piperacillin-tazobactam was administered as empiric therapy for a urinary tract infection. Computed tomography of the abdomen without contrast material was performed and it showed emphysematous changes in the bladder wall (Picture). These findings suggested emphysematous cystitis. A blood culture on admission grew Escherichia coli. E. coli grown from her blood cultures was resistant to ampicillin, ampicillin/sulbactum, and cephazolin. The antimicrobial agent was de-escalated to ceftriaxone. Antimicrobial therapy with intravenous ceftriaxone for two weeks followed by oral cephalexin for two weeks was administred. Upon completion of the therapy, the emphysematous changes in her bladder returned to normal.

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The authors state that they have no Conflict of Interest (COI).