A Case of Concomitant Emphysematous Cystitis and Clostridium difficile Colitis with Pneumoperitoneum

Tariq, Tooba; Farishta, M.; Rizvi, Asad; Irfan, Furqan B.

doi:10.7759/cureus.2897

Cited by 5 publications

(11 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After a thorough literature review, we identified two reports of EC in the setting of infectious colitis [ 6 , 7 ]. Both of these patients had a history of type 2 diabetes mellitus, presented with C. difficile colitis, and had evidence of EC on CT scan.…”

Section: Discussionmentioning

confidence: 99%

“…Both of these patients had a history of type 2 diabetes mellitus, presented with C. difficile colitis, and had evidence of EC on CT scan. However, only one of them had a concomitant UTI [ 6 ]. The presence of EC without any evidence of a UTI is not very common.…”

Section: Discussionmentioning

confidence: 99%

“…The association between colonic inflammation and EC is poorly understood. One possible explanation is bacterial translocation within the abdomen from the disruption of the mucosal barriers secondary to chronic inflammation [ 6 , 23 ]. A similar mechanism is seen in severe IBD [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…There have been multiple reports of EC in the setting of infectious colitis, both with and without any microbiological evidence of a concurrent UTI [ 6 , 7 ]. Acute colonic inflammation from diverticulitis has also been associated with EC, some cases of which were in the context of fistula formation between the colonic diverticula and the bladder [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Emphysematous cystitis as a potential marker of severe Crohn's disease

Hasan

Salh

2022

BMC Gastroenterol

View full text Add to dashboard Cite

Background Emphysematous cystitis (EC) is characterized by the presence of air within the bladder wall, often a complication of urinary tract infection (UTI) by gas-producing organisms. However, EC has also been reported in the setting of infectious colitis suggesting an alternate etiology. We report a rare case of EC in the setting of severe Crohn’s colitis with no clinical evidence of UTI. Case presentation A 43-year old female presented with a 2-month history of bloody diarrhea consisting of 8–12 bowel movements a day, weight loss of 10 kg and peripheral edema. She also had multiple ulcerated lesions on her abdominal wall and in the perianal region. Initial CT scan was significant for pancolitis, anasarca and EC. The follow-up CT cystogram, flexible cystoscopy and pelvic MRI confirmed the diagnosis of EC and ruled out any fistulous tracts in the pelvis including enterovesical/colovesical fistula. The patient did not report any urinary symptoms and the urinalysis was within normal limits. An extensive infectious workup was negative. Despite the paucity of infectious findings, the EC was empirically treated with an intravenous third-generation cephalosporin. Colonoscopy was significant for multiple ulcerated and hyperemic areas with pseudopolyps all throughout the right, transverse and left colon. Biopsies confirmed Crohn’s colitis with no evidence of granulomata or dysplasia. Immunohistochemistry was negative for CMV. The perianal and abdominal wall lesions were suspected to be pyoderma gangrenosum although biopsies were equivocal. The colitis was initially treated with intravenous steroids followed by biologic therapy with Infliximab. Despite appropriate escalation of therapies, the patient developed colonic perforation requiring subtotal colectomy. Conclusion This is a rare case of EC in a patient with severe Crohn’s colitis. There was no evidence of urinary tract infection or fistulising disease. According to our review, this is the first reported incident of EC in a patient with inflammatory bowel disease without any prior intra-abdominal surgeries. While active Crohn’s disease alone is a critical illness, we conclude that concomitant EC may be a poor prognostic factor.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Emphysematous cystitis as a potential marker of severe Crohn's disease

Hasan

Salh

2022

BMC Gastroenterol

View full text Add to dashboard Cite

show abstract

“…Gangrenous/emphysematous inflammation may occur in the stomach [33,66] (see Figures 16 and 17), esophagus [67], colorectum [68] (see Figures 15 and 18), urinary bladder [69,70], ureter [71], urethra [72], penis [73], epididymis/testis [74,75], endometrium [76], vagina [77], breast [78], bone [79], striated muscle [80], aorta [81], mediastinum [82], and endocardium [83]. Most cases are categorized in the nonclostridial etiology.…”

Section: Gangrenous/emphysematous Inflammation In Other Organsmentioning

confidence: 99%

Pathology of Gangrene

Tsutsumi¹

2020

Pathogenic Bacteria

View full text Add to dashboard Cite

Pathological features of gangrene are described. Gangrene is commonly caused by infection of anaerobic bacteria. Dry gangrene belongs to noninfectious gangrene. The hypoxic/ischemic condition accelerates the growth of anaerobic bacteria and extensive necrosis of the involved tissue. Clostridial and non-clostridial gangrene provokes gas formation in the necrotic tissue. Acute gangrenous inflammation happens in a variety of tissues and organs, including the vermiform appendix, gallbladder, bile duct, lung, and eyeball. Emphysematous (gas-forming) infection such as emphysematous pyelonephritis may be provoked by Escherichia coli and Klebsiella pneumoniae. Rapidly progressive gangrene of the extremities (so-called “flesh-eating bacteria” infection) is seen in fulminant streptococcal, Vibrio vulnificus, and Aeromonas hydrophila infections. Fournier gangrene is an aggressive and life-threatening gangrenous disease seen in the scrotum and rectum. Necrotizing fasciitis is a subacute form of gangrene of the extremities. Of note is the fact that clostridial and streptococcal infections in the internal organs may result in a lethal hypercytokinemic state without association of gangrene of the arms and legs. Uncontrolled diabetes mellitus may play an important role for vulnerability of the infectious diseases. Pseudomonas-induced malignant otitis externa and craniofacial mucormycosis are special forms of the lethal gangrenous disorder.

show abstract

Epidemiological characteristics of infections caused by bacteria Clostridioides difficile toxins

Koprivica,

Djekic-Malbasa

2024

Srp Arh Celok Lek

View full text Add to dashboard Cite

Introduction/Objective. Clostridioides difficile is one of the most common infective agent and important cause of infections causes of infections among hospitalized patients, often resulting in severe and potentially fatal outcomes. The aim of this study was to determine demographical characteristics (age and gender distribution) and outcomes among hospitalized patients with Clostridioides difficile infection (CDI), and to analyse differences in toxin A, toxin B or toxin A/B prevalence among hospitalized patients with CDI. Methods. Retrospective descriptive analysis of 200 patients hospitalized in the Institute for Pulmonary Diseases of Vojvodina (Serbia) in the period from 2015 to 2018 was performed. The data were obtained using a standardized "Active surveillance of Clostridioides difficile" questionnaire. A non-parametric ?? test and binominal logistic regression was used to validate all hypotheses: focusing on higher infection rates and mortality in the elderly compared to younger populations, and the predominance of diagnostic methods isolating both toxins A and B. Results. There are statistically significant differences in the distribution of infection cases among age groups, particularly with a higher prevalence in individuals aged 66 and older, (p < 0.001). There is a statistically significant difference in the frequency of respondents in relation to the detection of toxins. Percentage of representation of toxins is 61.5%. Conclusion. The results show that the most common diagnostic method is the detection of toxins A and B, rather than isolating either toxin independently. However, the study suggests that certain diagnostic methods should be supplemented by other newer diagnostic methods.

show abstract

A Case of Concomitant Emphysematous Cystitis and Clostridium difficile Colitis with Pneumoperitoneum

Cited by 5 publications

References 16 publications

Emphysematous cystitis as a potential marker of severe Crohn's disease

Emphysematous cystitis as a potential marker of severe Crohn's disease

Pathology of Gangrene

Epidemiological characteristics of infections caused by bacteria Clostridioides difficile toxins

Contact Info

Product

Resources

About