Emphysematous cystitis is a rare disease characterized by primary infection of the urinary bladder with gas-producing pathogens but the least morbid infection of the entire urinary tract. Clinical symptoms are nonspecific and diagnostic clues often arise from the imaging findings. We report a case of emphysematous cystitis in a 75-year-old diabetic male patient who presented with gross hematuria and irritative bladder symptoms. Treatment consisted of adequate urinary drainage, with suprapubic percutaneous drainage, empirical antibiotic therapy, and blood sugar control. The patient recovered satisfactorily after 7 days of hospitalization.