We report the case of a 58-year-old male patient with a history of hypertension, type 2 diabetes mellitus treated with insulin and vasculitis of the central system of recent diagnosis in nervous treatment prednisone and azathioprine.
The patient was admitted due to a 10 kg weight loss in one month, malaise and gait instability, with motor and sensory impairment of the lower limbs.
Whole-body PET-CT was performed in order to rule out a cause for malignancy, which showed an air image that circumscribed the bladder contour in isolation, without compromising the upper urinary tract compatible emphysema,
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Upon directed questioning the patient reported having pneumaturia, dysuria, pollakiuria, bladder tenesmus, push and fever a week before admission, without chills.
No recent hospitalization or instrumentation of the urinary tract.
Urine sediment showed leukocyturia > 50 GB/field, without hematuria.
Urocultivation (VITEK 2) was positive for aerogenes peripheral blood (resistant to cephaloporins) and inflammatory parameters were normal (CRP < 1 mg/dL, ESR 5 mm, leukocytes in blood 7.900).
Normal renal function (creatininemia 0.89 mg/dL, VFG > 60 ml/min).
The patient was admitted in good general condition, hemodynamically stable and afflicted.
Bladder catheterization, strict metabolic control with insulin and parenteral antibiotic treatment with imipenem were indicated, considering antibiogram, patient's condition and immunosuppression, completing 14 days of treatment.
The etiology was favorable, with fever, without hemodynamic compromise or significant alteration of septic parameters.
The patient was discharged after 21 days of hospitalization, asymptomatic, maintaining a bladder catheter and with bladder air image in regression in a simple control X-ray.
The patient came to follow-up one month after discharge in good general condition, without urinary symptoms.
A simple renal X-ray was requested, showing complete regression of the signs of bladder emphysematous cyst, so it was decided to remove the bladder catheter.
