Unusual Presentation of Emphysematous Cystitis: A Case Report and Review of the Literature

Abstract

Emphysematous cystitis (EC) is a rare form of urinary tract infection characterized by the spontaneous formation of air which is floated in the bladder and/or bladder wall. The sometimes severe prognosis depends on the delay in management. We describe the case of a patient followed for multiple myeloma undergoing chemotherapy who presented with emphysematous cystitis in this context of immunosuppression, with a narrative review of the literature. A 77-year-old woman patient with multiple myeloma in the palliative stage of chemotherapy was brought to the emergency room by her family for unusual asthenia and diffuse pain that had been developing for 72 hours. The interview did not reveal any lower urinary tract symptoms or fever. The biological assessment revealed a biological inflammatory syndrome with a C-Reactiv Protein of 300 mg/l and hyperleukocytosis of 14,000 elements /mm3. The urine dipstick was positive for leukocytes and nitrites. In view of this major biological inflammatory syndrome with no real clinical urinary point of call, a thoraco-abdomino-pelvic CT scan without injection of contrast medium was carried out as a matter of urgency and revealed the presence of air bubbles in the bladder wall and the underlying soft tissues. Treatment consisted of trans-urethral bladder catheterisation and double antibiotic therapy with amiklin and imipenem. Cytobacteriological examination of the urine revealed quinolone-sensitive Escherichia coli at day 4, leading to a switch from TIENAM to ofloxacin for 14 days. A follow-up CT scan at day 7 showed regression of aerial infiltration of the bladder wall and extra-vesical aerial images. Emphysematous cystitis is a rare form of acute inflammation of the bladder mucosa and underlying muscularis. The clinical picture of emphysematous cystitis is often aspecific. The prognosis depends on the early diagnosis and the quality of the management, i.e. bladder drainage and broad-spectrum probabilistic antibiotic therapy.