LAUSR

A 66-year-old woman, whose hemoglobin A1c level was 7.3%, with CKD stageG5/A3 due to diabetic nephropathy was admitted with chill and lower abdominal pain. Computed tomography (CT) imaging demonstrated a right hydronephrosis without ureteral stenosis (Fig. 1a, b) and distension of the urinary bladder with diffuse intramural gas (Fig. 1c, d). A Foley catheter was placed and intravenous antibiotics initiated. Subsequently, urine cultures and blood cultures were positive for Escherichia coli. A diagnosis of emphysematous cystitis (EC) with right hydronephrosis and sepsis was made, and she recovered well and was discharged 18 days after admission. EC is a rare gas-forming infection of the bladder wall, and potentially fatal [1]. EC may subsequently develop into pyelonephritis, including emphysematous pyelonephritis [1]; however, it is unusual to complicate by unilateral hydronephrosis [1, 2]. Even with unilateral hydronephrosis, EC should be considered for differential diagnosis, and it requires prompt treatment.