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A 91-year-old male on treatment for type 2 diabetes mellitus was admitted to our hospital complained of general fatigue and high-grade fever since one day. He noticed hematuria for two days before admission. On physical examination, costovertebral angle tenderness pain was not observed. His body temperature was 39.1 °C, and heart rate was 110 beats per minute. Blood laboratory examination showed that white blood cell counts were 18,050/L, C-reactive protein 17.9 mg/dL, blood sugar was 254 mg/dL, and procalcitonin was 10.1 ng/mL. Urinalysis revealed moderate hematuria and proteinuria. On plain pelvic X-ray [computed tomography (CT) scan positioning image], unique linear circular-shaped gas was observed (arrow in Figure 1A). On plain abdominal CT demonstrated mildly thickened bladder wall and emphysematous region of bladder lumen (arrow in Figure 1B). We diagnosed this case as emphysematous cystitis. Urine culture revealed Staphylococcus aureus as the pathogen of this case. Intravenous administration of ampicillin sodium/ sulbactam sodium (3.0 g every 8 hour for seven days) was started and a balloon catheter was placed in the bladder. Then hematuria was improved. After seven days of treatment, administration of ampicillin sodium/ sulbactam sodium and placement of ballooned-bladder catheter were discontinued. Moreover, the patient was discharged ten days after admission.

High-grade fever and unique shaped gas in pelvic region