Background: Emphysematous cystitis is a rare infection of the lower urinary tract characterized by gas pockets in the urinary bladder. E. coli is the most common causative organism, followed by Klebsiella and Enterobacter. It commonly occurs in old age patients with comorbidities, such as DM, bladder outlet obstruction, and immunosuppression. The symptoms include abdominal pain, dysuria, urgency, urinary frequency, hematuria, fever and rarely pneumaturia. It is usually diagnosed on CT abdomen and treated with IV antibiotics.
Case Report: This is a case of 69 years old Hispanic male with past medical history of uncontrolled diabetes mellitus, colorectal carcinoma s/p hemicolectomy and colostomy, recently diagnosed with brain and lung metastasis. The patient was admitted secondary to hematuria of one day duration without any fever, abdominal pain, dysuria, urgency or urinary frequency. Vital signs were stable and systemic examination was unremarkable. CT of the abdomen/pelvis showed gas pockets in bladder wall. He was treated with IV piperacillin/tazobactam.
Conclusions: The patient with emphysematous cystitis presents similar to one with simple UTI. A high index of suspicion is needed to diagnose this infection in an old patient with multiple comorbidities, as this is a very lethal condition if not recognized and treated early with IV antibiotics.

Keywords: emphysematous cystitis, Rare lower urinary tract infection, Hematuria