Uncommon diagnosis of an emphysematous cystitis
Abstract
A case of a 79-year-old woman who developed emphysematous cystitis (EC) prior to scheduled lower back surgery suffering from severe back pain was presented. She had neither of the known EC risk factors (diabetes mellitus, immunodeficiency, neurogenic bladder and recurrent urinary tract infections) and presented herself without classical signs of EC (dysuria, haematuria, abdominal pain, pollakiuria, pneumaturia). She had a persistent back pain that was masked by her chronic back condition, leucocytosis and increased C-reactive protein (CRP) concentrations. The abdominal ultrasound showed a suspiciously impeded, cloudy vision in the lower pelvis and a blurry, thickened presentation of the wall of the urinary bladder with high echogenicity. A CT scan of the abdomen was performed and confirmed the diagnosis of an emphysematous cystitis, as well as a secondary pyelonephritis Escherichia coli was isolated from urine and blood and successfully treated with ciprofloxacin. Contrast-enhanced CT imaging is the diagnostic method of choice.
References
Eken A, Alma E. Emphysematous cystitis: the role of CT imaging and appropriate treatment. Can Urol Assoc J 2013;7(11-12):E754-6.
Schicho A, Stroszczynski C, Wiggermann P. Emphysematous cystitis: mortality, risk factors, and pathogens of a rare disease. Clin pract 2017;7(2):930. doi: 10.4081/cp.2017.930. eCollection 2017 Apr 6.
Quint HJ, Drach GW, Rappaport WD, Hoffmann CJ. Emphysematous cystitis: a review of the spectrum of disease. J Urol 1992;147(1):134–7.
Ankel F, Wolfson AB, Stapczynski JS. Emphysematous cystitis: a complication of urinary tract infection occurring predominantly in diabetic women. Ann Emerg Med 1990;19(4):404–6.
Grupper M, Kravtsov A, Potasman I. Emphysematous cystitis: illustrative case report and review of the literature. Medicine 2007;86(1):47–53.
Sharma R, Mitra SK, Choudhary A, Majee P. Emphysematous cystitis-gas in bladder: a rare urological emergency. BMJ Case Rep 2015 Jul 23;2015. pii: bcr2015210836. doi: 10.1136/bcr-2015-210836.
Toyota N, Ogawa D, Ishii K, Hirata K, Wada J, Shikata K, et al. Emphysematous cystitis in a patient with type 2 diabetes mellitus. Acta Med Okayama 2011;65(2):129–33.
Thomas AA, Lane BR, Thomas AZ, Remer EM, Campbell SC, Shoskes DA. Emphysematous cystitis: A review of 135 cases. BJU Int 2007;100(1):17–20.
Kumar A, Turney JH, Brownjohn AM, McMahon MJ. Unusual bacterial infections of the urinary tract in diabetic patients--rare but frequently lethal. Nephrol Dial Transplant 2001; 16(5):1062–5.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).