Abdominal Pain and Fever in an Elderly Patient with Diabetes Mellitus

A 62-year-old man presented to the emergency department with a 5-day history of severe abdominal pain with low-grade fever. Medical history included diabetes mellitus and hypertension. He had tachycardia, hypotension, and diffuse abdominal tenderness. Investigations showed white blood cell counts of 22,400/mm3 (4000–10,000/mm3), blood urea of 180 mg/dl (9–43 mg/dl), creatinine of 1.8 mg/dl (0.66–1.25 mg/dl), and procalcitonin of 180 ng/ml (<0.5 ng/ml). Urinalysis showed plenty of white blood cells and red blood cells on microscopy. Contrast-enhanced computed tomography scans showed multiple air bubbles in the bladder wall, suggestive of emphysematous cystitis (EC) (Figure 1A), with tracking of the gas in the pelvicalyceal system of the left kidney (Figure 1B). Two ill-defined saccular …