A chronic infectious bladder stone causing an obstructive emphysematous cystitis.

A 69-year-old patient with medical history of urinary chronic infection was admitted to the intensive care unit for severe urinary tract infection complicated with septic shock, abdominal guarding and lactic metabolic acidosis. An abdominal CT scan (fig. 1A) identified signs of peritonitis, a ruptured emphysematous cystitis, a large bladder stone and multiple sites of nephritis. The initial course of the illness was marked by septic shock requiring hemodynamic support, acute kidney injury needing renal replacement therapy and respiratory failure requiring mechanical ventilation.