Abstract
Emphysematous cystitis (EC) is an uncommon and potentially serious urinary tract infection (UTI) characterized by gas formation within the bladder wall or lumen, frequently observed in patients with diabetes mellitus (DM). We report the case of a 76-year-old female with a history of atrial fibrillation (aFib) and heart failure (HF), who was incidentally diagnosed with EC on imaging during the evaluation of transient gross hematuria. She was clinically asymptomatic, with negative urine and blood cultures, and no systemic signs of infection. Notably, she was taking empagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor. The patient was managed conservatively with antibiotics, foley catheterization, and discontinuation of empagliflozin, with complete radiographic resolution of EC. This case highlights the hypothesis of potential association between SGLT2 inhibitors and EC. In our case, conservative treatment and removal of empagliflozin led to a complete resolution of EC.