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A patient with urgency, frequency, and low serum C reactive protein concentration

Q1: What do the computed tomogram and abdominal erect film show?
The pelvic computed tomogram (CT) showed typical intramural and intraluminal air bubbles accumulation in the urinary bladder (fig 1). Abdominal erect film taken right after the computed tomogram also showed a clear picture of curvilinear gas along the bladder wall (fig 2).

Q2: What is the diagnosis?
Emphysematous cystitis, glycosaemia, and hypokalaemia were proposed.

Q3: What is the appropriate treatment for this patient?
The treatment of emphysematous cystitis is by controlling glycosuria, glycosaemia, and systemic antibiotics. Drainage of urine is also suggested. If these treatments are not successful, surgical debridement is required.

Prognosis
The patient had hypokalaemia and was treated immediately. At the same time, she was treated with urinary drainage, antibiotics, and blood sugar control. However, she was admitted to the intensive care unit because of respiratory failure, septic shock, and an episode of seizure attack. Urinary culture showed Escherichia coli infection. After 25 days in the intensive care unit and antiepileptic drug treatment, her condition became stable and she was transferred to a . . . [Full text of this article]