A Case of Concomitant Emphysematous Cystitis and Clostridium difficile Colitis with Pneumoperitoneum

Tariq, Tooba; Farishta, M.; Rizvi, Asad; Irfan, Furqan B.

doi:10.7759/cureus.2897

Cited by 4 publications

(11 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After a thorough literature review, we identified two reports of EC in the setting of infectious colitis [ 6 , 7 ]. Both of these patients had a history of type 2 diabetes mellitus, presented with C. difficile colitis, and had evidence of EC on CT scan.…”

Section: Discussionmentioning

confidence: 99%

“…Both of these patients had a history of type 2 diabetes mellitus, presented with C. difficile colitis, and had evidence of EC on CT scan. However, only one of them had a concomitant UTI [ 6 ]. The presence of EC without any evidence of a UTI is not very common.…”

Section: Discussionmentioning

confidence: 99%

“…The association between colonic inflammation and EC is poorly understood. One possible explanation is bacterial translocation within the abdomen from the disruption of the mucosal barriers secondary to chronic inflammation [ 6 , 23 ]. A similar mechanism is seen in severe IBD [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…There have been multiple reports of EC in the setting of infectious colitis, both with and without any microbiological evidence of a concurrent UTI [ 6 , 7 ]. Acute colonic inflammation from diverticulitis has also been associated with EC, some cases of which were in the context of fistula formation between the colonic diverticula and the bladder [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Emphysematous cystitis as a potential marker of severe Crohn's disease

Hasan

Salh

2022

BMC Gastroenterol

View full text Add to dashboard Cite

Background Emphysematous cystitis (EC) is characterized by the presence of air within the bladder wall, often a complication of urinary tract infection (UTI) by gas-producing organisms. However, EC has also been reported in the setting of infectious colitis suggesting an alternate etiology. We report a rare case of EC in the setting of severe Crohn’s colitis with no clinical evidence of UTI. Case presentation A 43-year old female presented with a 2-month history of bloody diarrhea consisting of 8–12 bowel movements a day, weight loss of 10 kg and peripheral edema. She also had multiple ulcerated lesions on her abdominal wall and in the perianal region. Initial CT scan was significant for pancolitis, anasarca and EC. The follow-up CT cystogram, flexible cystoscopy and pelvic MRI confirmed the diagnosis of EC and ruled out any fistulous tracts in the pelvis including enterovesical/colovesical fistula. The patient did not report any urinary symptoms and the urinalysis was within normal limits. An extensive infectious workup was negative. Despite the paucity of infectious findings, the EC was empirically treated with an intravenous third-generation cephalosporin. Colonoscopy was significant for multiple ulcerated and hyperemic areas with pseudopolyps all throughout the right, transverse and left colon. Biopsies confirmed Crohn’s colitis with no evidence of granulomata or dysplasia. Immunohistochemistry was negative for CMV. The perianal and abdominal wall lesions were suspected to be pyoderma gangrenosum although biopsies were equivocal. The colitis was initially treated with intravenous steroids followed by biologic therapy with Infliximab. Despite appropriate escalation of therapies, the patient developed colonic perforation requiring subtotal colectomy. Conclusion This is a rare case of EC in a patient with severe Crohn’s colitis. There was no evidence of urinary tract infection or fistulising disease. According to our review, this is the first reported incident of EC in a patient with inflammatory bowel disease without any prior intra-abdominal surgeries. While active Crohn’s disease alone is a critical illness, we conclude that concomitant EC may be a poor prognostic factor.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Emphysematous cystitis as a potential marker of severe Crohn's disease

Hasan

Salh

2022

BMC Gastroenterol

View full text Add to dashboard Cite

show abstract

“…Gangrenous/emphysematous inflammation may occur in the stomach [33,66] (see Figures 16 and 17), esophagus [67], colorectum [68] (see Figures 15 and 18), urinary bladder [69,70], ureter [71], urethra [72], penis [73], epididymis/testis [74,75], endometrium [76], vagina [77], breast [78], bone [79], striated muscle [80], aorta [81], mediastinum [82], and endocardium [83]. Most cases are categorized in the nonclostridial etiology.…”

Section: Gangrenous/emphysematous Inflammation In Other Organsmentioning

confidence: 99%

Pathology of Gangrene

Tsutsumi¹

2020

Pathogenic Bacteria

View full text Add to dashboard Cite

Pathological features of gangrene are described. Gangrene is commonly caused by infection of anaerobic bacteria. Dry gangrene belongs to noninfectious gangrene. The hypoxic/ischemic condition accelerates the growth of anaerobic bacteria and extensive necrosis of the involved tissue. Clostridial and non-clostridial gangrene provokes gas formation in the necrotic tissue. Acute gangrenous inflammation happens in a variety of tissues and organs, including the vermiform appendix, gallbladder, bile duct, lung, and eyeball. Emphysematous (gas-forming) infection such as emphysematous pyelonephritis may be provoked by Escherichia coli and Klebsiella pneumoniae. Rapidly progressive gangrene of the extremities (so-called “flesh-eating bacteria” infection) is seen in fulminant streptococcal, Vibrio vulnificus, and Aeromonas hydrophila infections. Fournier gangrene is an aggressive and life-threatening gangrenous disease seen in the scrotum and rectum. Necrotizing fasciitis is a subacute form of gangrene of the extremities. Of note is the fact that clostridial and streptococcal infections in the internal organs may result in a lethal hypercytokinemic state without association of gangrene of the arms and legs. Uncontrolled diabetes mellitus may play an important role for vulnerability of the infectious diseases. Pseudomonas-induced malignant otitis externa and craniofacial mucormycosis are special forms of the lethal gangrenous disorder.

show abstract

Monomicrobial Necrotizing Fasciitis and Emphysematous Cystitis: Autopsy Report and Literature Review

2022

Ann Case Report

View full text Add to dashboard Cite

Necrotizing fasciitis (NF) and emphysematous cystitis (EC) are life-threatening conditions even with appropriate and rapid medical and surgical treatment. Herein, we report a case of a 65-year-old male patient who presented with concomitant EC and NF of the left thigh. The patient was managed with an emergency debridement of the left thigh shortly after arrival along with broad-spectrum antibiotic and fluid resuscitation. Tissue culture was positive for Clostridium perfringens. Despite the prompt management, the subcutaneous emphysema extended to gluteal, scrotal regions and to posterior abdominal wall muscles. The evolution was complicated by distributive shock and subsequently by multiple organ failure leading to death within 24 hours after the emergency room admission. To the best of our knowledge, this is the first case of concomitant EC and NF caused by Clostridium perfringens leading to death despite intensive treatment. Moreover, it is the first case providing clinical, radiologic, microbiologic and postmortem pathologic results.

show abstract

A Case of Concomitant Emphysematous Cystitis and Clostridium difficile Colitis with Pneumoperitoneum

Cited by 4 publications

References 16 publications

Emphysematous cystitis as a potential marker of severe Crohn's disease

Emphysematous cystitis as a potential marker of severe Crohn's disease

Pathology of Gangrene

Monomicrobial Necrotizing Fasciitis and Emphysematous Cystitis: Autopsy Report and Literature Review

Contact Info

Product

Resources

About