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KMID : 0882420090770040448
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Korean Journal of Medicine
2009 Volume.77 No. 4 p.448 ~ p.449
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Emphysematous cystitis in a patient with type 1 diabetes
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Lee Seung-Hwan
Cha Bong-Youn
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Abstract
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A 32?year?old woman presented with general weakness and low abdominal discomfort for 7 days. She had been diagnosed with type 1 diabetes at the age of 16 and was being treated with continuous subcutaneous insulin injections. Acute pyelonephritis had occurred three times previously and vesicoureteral reflux had been documented. On admission, hematuria, pyuria, and bacteriuria were noted with a leukocyte count of 10,410 mm-3 and elevated C?reactive protein level (16.8 mg/dL). A kidney/ureter/bladder (KUB) X-ray and pelvic computed tomography (Fig. 1) showed an air density delineating the bladder wall, which was diagnostic of emphysematous cystitis. Klebsiella pneumoniae was cultured in the urine specimen. The patient recovered fully after a 2?week treatment with cefuroxime (Fig. 2). Emphysematous cystitis is a potentially life?threatening infection that usually develops in patients with diabetes mellitus, neurogenic bladder, recurrent urinary tract infection, or urinary tract outlet obstruction1,2). As this disease has variable clinical features and course, it should be suspected in diabetics with urinary tract infection and worsening renal function. Although surgical management
is sometimes required, antibiotics, bladder drainage, and glycemic control are the mainstay of treatment.
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KEYWORD
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Diabetes mellitus, Emphysematous cystitis
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