[Emphysematous cystitis due to Clostridium perfringens--a localised infection in a man with generalized melanoma]

Emphysematous cystitis was found at autopsy of a 47-year-old man suffering from generalised malignant melanoma. Bacteriological cultures from the urinary bladder showed Escherichia coli, Klebsiella sp. and Clostridium perfringens type A, toxic strain. The histological examination revealed cystic dilatation of lymphatic vessels both in bladder mucosa and muscularis propria. There were multinucleated macrophages in the lining of some of these cystic spaces and a few Gram-positive rods inside their lumina. In the mucosal and submucosal connective tissue there were signs of chronic inflammation and, focally, small haemorrhages. We suppose that the gas production was due to the presence of Clostridium perfringens and believe that the infection of the urinary bladder occurred in relation to the repeated insertion of the catheter into the bladder of a patient with secondary immunosuppression. Emphysematous cystitis was, in our case, a localised clostridial infection without clinical and morphological signs of generalised septicaemia.