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Department of Internal Medicine, Hospital de Cascais. Av. Brigadeiro Victor Novais Gonçalves, Alcabideche 2755-009, PortugalNOVA National School of Public Health, Universidade NOVA de Lisboa. Av. Padre Cruz, Lisboa 1600-560, Portugal
A 73-year-old woman with past history of dementia and type 2 diabetes mellitus (DM) was admitted to the emergency department because of drowsiness and hyperglycaemia. The capillary blood glucose was 335 mg/dL and capillary ketone levels were in the normal range. Physical examination was unremarkable. During hospital stay, she developed fever (38.9°C). The laboratory tests revealed leucocytosis (white blood cell count of 16.25 × 109/L) with neutrophilia and a C-reactive protein of 3.61mg/dL. The liver function panel revealed cytolysis and cholestasis. Leucocyte esterase was strongly positive in urinalysis. An abdominopelvic computed tomography (CT) was ordered. The main finding was the presence of gas within the bladder lumen (Fig. 1). What is the diagnosis?
Fig. 1(A, B) Axial and sagittal views of CT-scan images showing gas within the bladder lumen (white arrows).
]. The radiological diagnosis should lead to the prompt onset of antibiotic therapy, a key factor to minimize the likelihood of an adverse outcome. A delay in diagnosis and treatment can result in the development of bladder rupture, emphysematous pyelonephritis, sepsis and death [
In this case, Escherichia coli was isolated from urine culture and pneumaturia was present at the time of bladder catheterization (a highly specific finding, observed in 70% of patients with EC submitted to the procedure) [
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