A case of abdominal distress and kidney dysfunction in a patient with diabetes.

Abstract

A 65-year-old male with diabetes mellitus and dyslipidemia presented with a fever and dysuria for the past week. He developed hematuria, lower abdominal discomfort, and constipation. During examination, tachycardia (120 beats per min) and relative hypotension (96/57 mmHg) were observed. Laboratory tests revealed acute kidney injury with metabolic acidosis (serum creatinine of 5.47 mg/dL, pH value 7.29 BE: −7.7). Kidney, ureter, and bladder imaging showed bladder distension with gas formation (Figure 1). An abdominal computed tomography scan revealed emphysematous cystitis (Figure 2). The patient was initially treated with foley irrigation and antibiotics, but he developed respiratory distress on the same day and was intubated for urosepsis. Blood and urine cultures showed Klebsiella pneumoniae. He received temporary hemodialysis due to refractory fluid overload and Kidney Disease Improving Global Outcomes (KDIGO) stage III acute kidney injury by serum creatinine criteria during hospitalization. Emphysematous urinary tract infections (UTIs) involve gas formation in the urinary tract and are commonly caused by Escherichia coli or Klebsiella pneumoniae, particularly in individuals with diabetes.1 Emphysematous cystitis is a rare type of UTI characterized by gas formation in the bladder wall. The symptoms include abdominal pain, dysuria, and pneumaturia. The diagnosis is made through imaging, and treatment involves antibiotics.2 In severe cases, hospitalization may be required. Emphysematous cystitis is a rare but serious complication of UTIs, particularly in individuals with diabetes. Early diagnosis and appropriate management, including antibiotics and surgical therapy, if necessary, are essential for improving outcomes.3 Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of our research.