Unexpected Etiology of Pure Macroscopic Hematuria: Emphysematous Cystitis

Emphysematous cystitis (EC) is a rare type of urinary tract infection characterized by the presence of gas in the bladder lumen. It is usually encountered in older women with uncontrolled diabetes mellitus (DM). Patients usually present with dysuria, hematuria, suprapubic pain, and less frequently, with pneumaturia. For definitive diagnosis, pathological examination is required but in most cases, computed tomography (CT) is adequate. With appropriate antibiotherapy and drainage; EC can be managed.Case Report: A 78-year-old woman who presented presented with hematuria was diagnosed with EC via CT scan. The patient was treated with antibiotherapy and placement of urethral Foley catheter.Conclusion: In the diagnosis and treatment of urinary tract infection in elderly women with uncontrolled DM, EC should be kept in mind because of its complications, and for suspicious cases, CT should be performed