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Emphysematous cystitis due to Klebsiella pneumoniae

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A 72-year-old woman with type 2 diabetes mellitus presented with sudden-onset back pain, fever, rigors and suprapubic tenderness. An abdominal x-ray and pelvic computed tomography scan (Figure) confirmed the diagnosis of emphysematous cystitis. Klebsiella pneumoniae was cultured from blood and urine samples, and the patient was treated with intravenous cephazolin followed by oral cephalexin.
She had a complete recovery.

Emphysematous cystitis is an uncommon but severe infection caused by gas-producing pathogens including
K. pneumoniae
.1 It should be considered in diabetic patients with symptoms of urinary tract infection, severe abdominal or pelvic pain and positive blood cultures.2 A history of pneumaturia is highly suggestive, but is rarely mentioned
by patients.3

Computed tomography image of the patient’s abdomen

Arrows show gas in the bladder wall.