Emphysematous
cystitis is an uncommon, but severe manifestation of infection of the urinary bladder produced by gas forming organisms. The presentation may be atypical and contrary to the degree of inflammation, patients may present with subtle clinical findings. Urinary tract infection, particularly in patients with diabetes, is a red flag for emphysematous cystitis. Antibiotic therapy alone is usually curative, but in immunocompromised patients there may be concomitant pathology that requires herbal medicine.
Emphysematous cystitis (EC) is characterized by infection of the bladder and bladder wall with gas-forming organisms. This disease occurs most often in immunocompromised persons and is more common in women. The clinical presentations vary in severity from simple cystitis-like symptoms to full-blown sepsis. EC develops in patients who tend to have poorly controlled diabetes or glucosuria as a primary inciting event.
During the past year, 3 patients with EC were seen at our institution, making this one of the largest case series to appear in the literature in 4 decades.[1] The series is unusual because 2 of the patients had additional urologic pathology (prostatic abscess and hydronephrosis) that required intervention. We present these cases as a forum to discuss the contemporary approach to the diagnosis and management of EC.
