Emphysematous cystitis, iliopsoas abscess, and pneumorrhachis in an elderly woman: a case report

Abstract

Background Emphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis. Case presentation This is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock. Conclusions Our case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.

Pneumorrhachis Secondary to Klebsiella pneumoniae Gas-Forming Paraspinal Abscess: A Case report and Review of Literature

“…In the second category, pneumorrhachis is primarily due to emphysematous infections affecting structures close to the spinal canal (vertebrae, paraspinal muscles, and retroperitoneal organs). Infections of structures away from the spine such as gastrointestinal tract (intra-abdominal sepsis) or infection complicating vascular line placement have also been reported [ 7 , 13 , 15 , 17 , 18 ]. Finally, the development of a fistula complicating infected sacral sores or malignancies (i.e., rectal tumor) can lead to CSF leak which can create a negative pressure effect resulting in air being sucked into the spinal column.…”

“Beyond the Bladder: Exploring the Intricacies of Emphysematous Cystitis and Its Surprising Associations”

“…Risk factors include old age and uncontrolled diabetes. Management of pneumoracchis depends upon treating the underlying cause; however, surgical intervention might be needed in case of spinal cord compression [ 21 ].…”

“…Complications of the disease can include bladder rupture, bladder dysfunction, obstruction of the urinary tract, which can eventually lead to bilateral renal [19]. Emphysematous is also a rare complication that has been reported in 2 cases as a result of Escherichia coli and 4 cases as a result of Klebsiella pneumoniae [21][22][23][24][25][26]. The possible mechanism involves bacterial infiltration leading to bladder distension and microscopic tears transiently, allowing bacterial seeding and entry into the intramural space.…”

Emphysematous Cystitis: A Rare Urologic Emergency

“…While most cases of genitourinary infection are uncomplicated and present with typical symptoms of dysuria, urinary frequency, and urgency, it is important to avoid overlooking the possibility of more severe conditions like EC in those patients with gross hematuria and severe abdominal or pelvic discomfort. Failure to recognize and promptly treat EC can lead to life-threatening complications, including bladder rupture, necrosis, abscess formation, and even septic shock [ 5 , 6 ].…”