High-grade fever and unique shaped gas in pelvic region

Abstract

A 91-year-old male on treatment for type 2 diabetes mellitus was admitted to our hospital complained of general fatigue and high-grade fever since one day. He noticed hematuria for two days before admission. On physical examination, costovertebral angle tenderness pain was not observed. His body temperature was 39.1 °C, and heart rate was 110 beats per minute. Blood laboratory examination showed that white blood cell counts were 18,050/L, C-reactive protein 17.9 mg/dL, blood sugar was 254 mg/dL, and procalcitonin was 10.1 ng/mL. Urinalysis revealed moderate hematuria and proteinuria. On plain pelvic X-ray [computed tomography (CT) scan positioning image], unique linear circular-shaped gas was observed (arrow in Figure 1A). On plain abdominal CT demonstrated mildly thickened bladder wall and emphysematous region of bladder lumen (arrow in Figure 1B). We diagnosed this case as emphysematous cystitis. Urine culture revealed Staphylococcus aureus as the pathogen of this case. Intravenous administration of ampicillin sodium/ sulbactam sodium (3.0 g every 8 hour for seven days) was started and a balloon catheter was placed in the bladder. Then hematuria was improved. After seven days of treatment, administration of ampicillin sodium/ sulbactam sodium and placement of ballooned-bladder catheter were discontinued. Moreover, the patient was discharged ten days after admission.

High-grade fever and gas region of bladder lumen on abdominal computed tomography

“…In this case, a gas image localized around wall of the bladder was observed, but free-air or ascites was not seen in the abdominal cavity. We have reported a similar case in the past [1]. However, unlike previous report, early diagnosis could be confirmed by abdominal CT.…”

“…Emphysematous cystitis is a rare disease, and is known as one of complications of diabetes mellitus [1,2]. In general, high fever is not seen in acute cystitis, but half of cases of emphysematous cystitis show high fever as in this case [1].…”

“…Emphysematous cystitis is a rare disease, and is known as one of complications of diabetes mellitus [1,2]. In general, high fever is not seen in acute cystitis, but half of cases of emphysematous cystitis show high fever as in this case [1]. According to previous reports, the mortality rate for emphysematous cystitis is about 7% when it progresses to septic conditions [2].…”