Emphysematous cystitis in a patient using immunosuppressant agents

Area of Science:

• Urology
• Infectious Diseases
• Immunology

Background:

• Immunocompromised patients are susceptible to severe urinary tract infections (UTIs).
• Rheumatoid arthritis patients on immunosuppressants like prednisolone and cyclosporine face increased infection risks.
• Emphysematous cystitis is a rare, severe UTI characterized by gas in the bladder wall.

Purpose of the Study:

• To highlight the importance of considering emphysematous cystitis in immunocompromised patients presenting with non-specific symptoms.
• To report a case of emphysematous cystitis in a patient with rheumatoid arthritis on immunosuppressive therapy.

Main Methods:

• Case report of a 72-year-old woman with rheumatoid arthritis.
• Clinical presentation including nausea, vomiting, and fever.
• Diagnostic imaging using computed tomography (CT) to detect gas in the bladder wall.

Main Results:

• Computed tomography confirmed the presence of gas within the bladder wall.
• Emphysematous cystitis was diagnosed in the patient.
• The patient's presentation lacked specific signs of a severe UTI, such as costovertebral angle tenderness.

Conclusions:

• Emphysematous cystitis should be considered in the differential diagnosis of severe UTIs in immunocompromised individuals, even with atypical symptoms.
• Prompt diagnosis and management are crucial for favorable outcomes in emphysematous cystitis.
• Immunosuppressive therapy for conditions like rheumatoid arthritis increases the risk of unusual infections such as emphysematous cystitis.