Emphysematous cystitis due to recurrent Clostridium difficile infection.

Area of Science:

• Gastroenterology
• Infectious Diseases
• Urology

Background:

• Clostridium difficile infection (CDI) is a significant cause of antibiotic-associated diarrhea.
• Pseudomembranous colitis is a severe manifestation of CDI.
• Gas in the bladder wall (emphysematous cystitis) is a rare complication, often associated with diabetes or urinary tract infections.

Observation:

• An elderly female patient with chronic constipation presented with acute diarrhea and abdominal pain.
• Exploratory laparotomy revealed no bowel ischemia, but subsequent testing confirmed Clostridium difficile.
• Abdominal imaging identified extensive pseudomembranous colitis and multiple gas foci within the bladder wall.

Findings:

• The patient was diagnosed with Clostridium difficile infection complicated by pseudomembranous colitis and emphysematous cystitis.
• Initial treatment with oral vancomycin followed by metronidazole for recurrent infection led to symptom resolution.
• A 6-week follow-up confirmed the resolution of diarrhea and abdominal cramping.

Implications:

• This case underscores the importance of considering CDI in elderly patients with acute abdominal symptoms, even with atypical presentations.
• The co-occurrence of pseudomembranous colitis and emphysematous cystitis highlights the potential systemic impact of C. difficile.
• Effective antibiotic management is crucial for resolving severe CDI and its complications, improving patient outcomes.