A 55-year-old man with a history of aortic valve replacement was admitted because of pelvic pain. He had been treated with antibiotics over the past 4 weeks for a presumed lower urinary tract infection with fever. Treatment had been unsuccessful. Both urine and blood cultures grew Enterobacter cloacae. Abdominal radiography showed a thin line of air within the bladder wall, outlining its perimeter .A bacteraemic emphysematous cystitis complicated by prosthetic valve endocarditis was diagnosed, and effective antibiotic treatment was initiated.

Emphysematous cystitis is a potentially life-threatening condition caused by gas-producing pathogens. This rare form of urinary tract infection typically occurs in middle-aged diabetic women. Contrary to radiological findings, clinical features are non-specific (irritative bladder symptoms, pyuria, haematuria, and, rarely, pneumaturia). Plain abdominal radiography, as well as ultrasonography, may lead to the diagnosis but CT scan is regarded as the procedure of choice, particularly to rule out a vesicocolic fistula. Early diagnosis and management consists of antibiotic therapy, bladder drainage, and sometimes surgery.

Source: Lancet