Emphysematous cystitis
Journal
International Journal of Infectious Diseases
Journal Volume
14
Journal Issue
3
Pages
e269-e270
Date Issued
2010
Author(s)
Abstract
A 74-year-old female with a history of diabetes mellitus, hypertension, dyslipidemia, and ischemic stroke, with a sequela of right hemiparesis, presented to our emergency room with fever, lower abdominal pain, and confused consciousness for one day. No cough, vomiting, diarrhea, or flank pain was present. Her blood urea nitrogen concentration was 57.2 mg/dl and the serum creatinine concentration was 1.7 mg/dl. Other laboratory tests showed an elevated white blood cell count of 27.42 × 109/l with 4% band forms and C-reactive protein of 15.4 mg/dl. Computed tomography of the abdomen and pelvis demonstrated a thickened bladder wall containing pockets of gas (Figure 1). Physical examination revealed no flank knocking tenderness and no abdominal pain or rebounding pain. Cultures of urine and blood grew more than 1 × 105 colonies of Escherichia coli that was sensitive to first-generation cephalosporins. The patient responded well to management with intravenous cefepime and urinary drainage by bladder catheterization; she was afebrile without further surgical debridement three days after the initial treatment. The parenteral antimicrobial therapy was then shifted to cefazolin according to the results of susceptibility testing. Computed tomography at 14 days after antibiotic treatment and urinary drainage revealed complete remission of the gas pockets. Emphysematous cystitis is a rare but severe infectious disease. The gas accumulation inside the bladder wall is considered as carbon dioxide produced by the fermentation of glucose or albumin by the pathogens infecting the bladder. The most common pathogens are E. coli, Enterobacter aerogenes, and Klebsiella pneumoniae.1Grupper M. Kravtsov A. Potasman I. Emphysematous cystitis—illustrative case report and review of the literature.Medicine (Baltimore). 2007; 86: 47-53Crossref PubMed Scopus (138) Google Scholar Half of all emphysematous cystitis patients have diabetes, and those patients with alcoholism, undernourishment, and in poor health condition are at increased risk for this disease. The mortality rate of this disease is about 10%.1Grupper M. Kravtsov A. Potasman I. Emphysematous cystitis—illustrative case report and review of the literature.Medicine (Baltimore). 2007; 86: 47-53Crossref PubMed Scopus (138) Google Scholar Ultrasonography and abdominal X-ray films are the first-line tools to survey patients with abdominal pain. Computed tomography is a better imaging modality with a high sensitivity and specificity for suspicious lesions, such as abnormal gas and anatomic extension. Early diagnosis is important for such a fulminant infection, and surgical debridement should be considered if there is a poor response to conservative management including antibiotic therapy and bladder drainage. Conflict of interest: No conflict of interest to declare.
Other Subjects
C reactive protein; cefazolin; cefepime; creatinine; nitrogen; urea; abdominal pain; aged; article; bladder catheterization; blood culture; case report; cerebrovascular accident; clinical assessment; computer assisted tomography; confusion; creatinine blood level; cystitis; diabetes mellitus; disease predisposition; drug sensitivity; dyslipidemia; emergency ward; Enterobacter aerogenes; Escherichia coli; female; hemiparesis; human; hypertension; Klebsiella pneumoniae; laboratory test; leukocyte count; urea nitrogen blood level; urine culture
Type
note