Emphysematous Cystitis: A Radiological Diagnosis of Potentially Life-Threatening Infection

Abstract

Urinary tract infections are very prevalent among women. The majority of urinary tract infections are uncomplicated and can be managed empirically with no further investigations. However, imaging studies may be indicated in patients with severe or persistent symptoms. Complicated urinary tract infections typically develop in the setting of diabetes mellitus. We report a case of a 52-year-old woman who presented to the emergency department with severe lower abdominal pain for two days that was associated with nausea, vomiting, and fever. There was no history of change in urine or bowel habits. Besides the history of well-controlled asthma, the patient was not known to have any comorbid medical condition. Upon examination, the patient had tachycardia, low-grade fever, and a localized suprapubic tenderness with guarding. Laboratory investigation revealed leukocytosis, elevated erythrocyte sedimentation rate and Creactive protein, and deranged renal functions. Further, urinalysis revealed numerous white blood cells, red blood cells, positive nitrite, and leukocyte esterase. A computed tomography scan demonstrated the presence of small locules of gas within the lumen and the wall of the bladder representing emphysematous cystitis. The patient was admitted to the intensive care unit. She received aggressive hydration therapy and a short course of opioid therapy for pain control. Broad-spectrum antibiotic therapy in the form of piperacillin-tazobactam was initiated. Over the following few days, the patient exhibited significant improvement in his symptoms and resolution of the laboratory parameters. Emphysematous cystitis is a rare infection of the lower urinary tract with gas formation. The case highlighted that such a condition may develop in the absence of diabetes mellitus or other risk factors. Prompt treatment is crucial as emphysematous cystitis can be life-threatening if the diagnosis is missed or delayed.

Scoring Systems to Evaluate the Mortality Risk of Patients with Emphysematous Cystitis: A Retrospective Observational Study

“…We speculated that the diagnosis of EC could be challenging to identify in those immunocompromised patients who used prednisolone, cyclosporine, actarit, etc., with atypical symptoms of UTI [ 2 , 25 , 26 , 27 ]. Thus, the diagnosis might have been delayed and the condition could become life-threatening, resulting in a higher mortality rate [ 28 ].…”

Emphysematous Cystitis: A Rare Urologic Emergency

“…Timely imaging to confirm the diagnosis with subsequent catheterization for bladder decompression and administration of broad-spectrum antibiotics can prevent fatal outcomes. Its tendency toward atypical presentations makes it imperative to consider EC even in non-diabetic patients and patients without the traditional risk factors [ 14 ]. Therefore, clinicians should remain alert to the possibility of EC in the emergent setting and strive for early intervention and treatment if identified.…”