An 84-year-old diabetic women receiving in-hospital stroke management began suffering from vague lower abdominal pain, increased urge incontinence and gross hematuria. Physical examination revealed suprapubic tenderness and a tympanic bladder. A computed tomography confirmed a distended bladder with gas foci delineating the bladder wall. Microbiology revealed an atypical multi-organism presentation of Klebsiella pneumoniae and Enterococcus species. Emphysematous cystitis is characterized by air within the bladder wall often found in elderly diabetic females. Predominant organisms include Escherichia coli and Klebsiella pneumonia. Prompt treatment is essential in this potentially fatal condition.