Alhusayni Shouq A, Alshammari Thekra H, Althomali Abdullah A, Alqahtani Mishari M, Alanazi Waad A, Alghamdi Mohammed A, AlDawsari Faisal M, Homoud Elan M, Alharbi Abdulrahman A, Althobaiti Khalid E, Alsubaihi Abdulrahman A, Alsayed Abdullah M, Albaqami Abdalmohsen M, Alamer Ahmad M, Al-Hawaj Faisal
College of Medicine, University of Hail, Hail, SAU.
College of Medicine, Taif University, Taif, SAU.
Cureus. 2021 Dec 6;13(12):e20201. doi: 10.7759/cureus.20201. eCollection 2021 Dec.
Urinary tract infections are very prevalent among women. The majority of urinary tract infections are uncomplicated and can be managed empirically with no further investigations. However, imaging studies may be indicated in patients with severe or persistent symptoms. Complicated urinary tract infections typically develop in the setting of diabetes mellitus. We report a case of a 52-year-old woman who presented to the emergency department with severe lower abdominal pain for two days that was associated with nausea, vomiting, and fever. There was no history of change in urine or bowel habits. Besides the history of well-controlled asthma, the patient was not known to have any comorbid medical condition. Upon examination, the patient had tachycardia, low-grade fever, and a localized suprapubic tenderness with guarding. Laboratory investigation revealed leukocytosis, elevated erythrocyte sedimentation rate and C-reactive protein, and deranged renal functions. Further, urinalysis revealed numerous white blood cells, red blood cells, positive nitrite, and leukocyte esterase. A computed tomography scan demonstrated the presence of small locules of gas within the lumen and the wall of the bladder representing emphysematous cystitis. The patient was admitted to the intensive care unit. She received aggressive hydration therapy and a short course of opioid therapy for pain control. Broad-spectrum antibiotic therapy in the form of piperacillin-tazobactam was initiated. Over the following few days, the patient exhibited significant improvement in his symptoms and resolution of the laboratory parameters. Emphysematous cystitis is a rare infection of the lower urinary tract with gas formation. The case highlighted that such a condition may develop in the absence of diabetes mellitus or other risk factors. Prompt treatment is crucial as emphysematous cystitis can be life-threatening if the diagnosis is missed or delayed.
尿路感染在女性中非常普遍。大多数尿路感染并不复杂，无需进一步检查即可凭经验进行处理。然而，对于症状严重或持续的患者，可能需要进行影像学检查。复杂性尿路感染通常在糖尿病患者中发生。我们报告一例52岁女性病例，该患者因严重下腹痛两天就诊于急诊科，伴有恶心、呕吐和发热。无尿便习惯改变史。除了哮喘控制良好的病史外，该患者无其他已知的合并症。检查时，患者有心动过速、低热，耻骨上有局限性压痛并伴有肌紧张。实验室检查显示白细胞增多、红细胞沉降率和C反应蛋白升高以及肾功能紊乱。此外，尿液分析显示有大量白细胞、红细胞、亚硝酸盐阳性和白细胞酯酶阳性。计算机断层扫描显示膀胱腔内和膀胱壁有小气泡，提示气肿性膀胱炎。患者被收入重症监护病房。她接受了积极的补液治疗和短期的阿片类药物治疗以控制疼痛。开始使用哌拉西林-他唑巴坦进行广谱抗生素治疗。在接下来的几天里，患者症状明显改善，实验室指标恢复正常。气肿性膀胱炎是一种罕见的下尿路感染并伴有气体形成。该病例强调，这种情况可能在没有糖尿病或其他危险因素的情况下发生。如果漏诊或延误诊断，气肿性膀胱炎可能危及生命，因此及时治疗至关重要。
