RESUMO
We report a 53 year-old woman with type 2 diabetes mellitus and hypertension, presenting with progressive abdominal pain lasting three weeks, associated with lower abdominal swelling and fever. Clinical examination showed a large increase in abdominal volume, contraction of extracellular compartment, and signs of severe sepsis. Computed tomography showed an over-distended bladder with severe wall and luminal pneumatosis and bilateral hydronephrosis. The diagnosis was of emphysematous cystitis associated to hydronephrosis. Urine and blood cultures were positive for multi-susceptible Escherichia coli. Clinical evolution was favorable after 6 weeks of ceftriaxone and urinary catheter use. Emphysematous cystitis is a rare clinical entity, with an associated mortality of 7%. Known predisposing factors are older age, female gender and presence of diabetes. Microbiological agents most frequently involved are Escherichia coli and Klebsiella pneumoniae (80% of cases). Medical treatment is preferred and is based on urinary tract decompression with a bladder catheter, and prolonged broad spectrum antimicrobial therapy.