An Unusual Case Presentation of Coexistence of Emphysematous Cystitis and Bilateral Emphysematous Pyelonephritis: A Case Report

Background: Emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) are severe emphysematous urinary tract infections with high mortality. Early diagnosis is often missed due to the lack of typical clinical manifestations. Case Presentation: A 64-year-old woman with type 2 diabetes was transferred to the emergency department for cough and expectoration with shortness of breath. A CT scan revealed gas formation in the bilateral renal pelvis, bilateral ureter, and bladder cavity. Urine bacterial cultures showed Escherichia coli and Streptococcus gallolyticus. The patient’s bladder was drained, and she was administered antibiotics, insulin, and a non-invasive ventilator. The gas disappeared completely, and the patient recovered uneventfully. Conclusion: This is the first reported case of Escherichia coli combined with Streptococcus gallolyticus infection in EC and EPN. More attention should be paid to EC and EPN in diabetes patients. Early conservative treatment is effective.