Concurrent emphysematous pyelonephritis, cystitis, and iliopsoas abscess from discitis in a diabetic woman A 60-year-old diabetic Taiwanese woman presented to the emergency department with lower back pain of 2-week duration. Physical examination revealed local tenderness over the lower back region; bilateral knocking pain was noted at the costovertebral angle. Laboratory investigations revealed a white blood cell (WBC) count of 4.5 Â 10 9 /l (normal value 4-11 Â 10 9 /l) with band forms of 2% and segmented neutrophils of 96%, creatinine of 2.3 mg/dl (normal value 0.7-1.4 mg/dl), C-reactive protein (CRP) of 25.32 mg/dl (normal value <0.3 mg/dl), blood glucose of 567 mg/ dl (normal value 70-110 mg/dl), and the presence of ketone bodies. Spot urine revealed pyuria. A spinal X-ray showed radiolucency along the bilateral psoas muscles, with extension International Journal of Infectious Diseases 51 (2016) 105-106 Figure 1. Anteroposterior view of the lumbar spine showing compression of the first lumbar spine, radiolucency along the bilateral psoas muscles (white arrows in A) suggestive of bilateral emphysematous iliopsoas abscess with extension to the left hip joint (black arrow in A), and air within the bladder (hollow black arrow in A) suggestive of emphysematous cystitis. The axial and coronal contrast-enhanced abdominal computed tomography (CT) scan views revealed compression of the first lumbar spine with air bubbles within the spine and spinal canal (pneumorrhachis), bilateral emphysematous iliopsoas abscess (white arrows in B and C) with extension to the left hip joint (black arrow in D), left emphysematous pyelonephritis (hollow white arrows in B and C), and emphysematous cystitis (hollow black arrow in D).