An Atypical Case of Concurrent Emphysematous Cystitis and Osteomyelitis in a Patient With Metastatic Cancer

Emphysematous cystitis (EC) is a rare, gas-forming bladder wall infection, most commonly caused by Escherichia coli (E. coli) and typically seen in diabetic or immunocompromised patients. We report a case of a 50-year-old female with breast cancer undergoing neoadjuvant chemotherapy who presented with hematuria, nausea, and vomiting. Imaging and laboratory workup revealed EC and concurrent osteomyelitis caused by Pseudomonas aeruginosa (P. aeruginosa). She was treated with extended antibiotic therapy, leading to stabilization of the osteomyelitis. This report highlights the unusual role of P. aeruginosa, a less common gas-producing organism, in the pathogenesis of EC. We also review two additional cases of EC in oncology patients undergoing chemotherapy, with the underlying microbe being Klebsiella pneumoniae (K. pneumoniae), and treated with appropriate antibiotics. These cases further emphasize the significance of EC in patients with metastatic cancer undergoing chemotherapy to prompt early investigation and guide treatment.