Title : Emphysematous cystitis in an immunocompromised patient with ovarian cancer: A case report
Abstract:
Background:
Emphysematous cystitis (EC) is a rare, potentially life-threatening urinary tract infection characterized by gas formation within the bladder wall or lumen. While most cases occur in older diabetic patients, EC may also develop in immunocompromised oncology patients, where overlapping risk factors complicate diagnosis and management.
Case Report:
We present a 67-year-old female with high-grade serous ovarian carcinoma receiving carboplatin and paclitaxel chemotherapy, with additional risk factors of chronic corticosteroid use, poorly controlled hyperglycemia (blood glucose 322 mg/dL, A1c 8.1%), and opioid-associated urinary retention. She was admitted for evaluation of gastrointestinal bleeding but reported several months of intermittent dysuria, hematuria, and straining to void.
On admission, she was afebrile, hemodynamically stable, and pancytopenic. Urinalysis revealed significant glucosuria, proteinuria, hematuria, positive nitrites, and bacteriuria. Computed tomography angiography of the abdomen and pelvis, obtained for the suspected gastrointestinal hemorrhage incidentally demonstrated extensive intramural gas within the bladder wall consistent with EC. Urine culture grew Klebsiella pneumoniae, sensitive to ceftriaxone. She was managed conservatively with intravenous ceftriaxone for 14 days, bladder decompression via Foley catheter, and supportive care. Follow-up imaging during subsequent admissions showed resolution of the EC.
Discussion:
This case highlights the diagnostic challenges of EC in non-diabetic immunocompromised hosts. Cytotoxic chemotherapy, corticosteroids, uncontrolled hyperglycemia, and urinary stasis created an ideal environment for gas-forming pathogens. While diabetes mellitus remains the most common risk factor, oncology patients undergoing chemotherapy may present atypically and require a high index of suspicion. Early cross-sectional imaging was pivotal in diagnosis, despite being ordered for an unrelated indication
Conclusion:
To our knowledge, this is the first reported case of EC in a patient receiving carboplatin and paclitaxel for ovarian cancer. Conservative management achieved full resolution. This case underscores the importance of considering EC in immunocompromised oncology patients presenting with even subtle urinary symptoms and highlights the role of early imaging and culture-guided antimicrobial therapy.
