Emphysematous cystitis with bilateral pyelonephritis in a pediatric patient with COVID-19

Abstract

A 15-year-old female adolescent with a medical history of recurrent urinary tract infections and grade 1 left-sided vesicoureteral reflux presented to the emergency room with abdominal and back pain. Labs revealed a haemoglobin A1c (HbA1c) of 9.1% and a random blood glucose of 200 mg/dL, consistent with new-onset diabetes mellitus. Nasopharyngeal COVID-19 PCR test returned positive. A CT scan of the abdomen and pelvis revealed bilateral attenuation of the kidneys and air in the bladder, which was confirmed by pelvic ultrasound. Gas subsequently resolved 2 days later after treatment with antibiotics, and a diagnosis of emphysematous cystitis was made. Emphysematous cystitis in the paediatric population is an extremely rare condition with four cases reported in the literature. Furthermore, there has been a reported association between COVID-19, cystitis and non-typical course of urinary symptoms. Local inflammation obstructing transportation of formed gas is one of the proposed mechanisms underlying emphysematous cystitis, and so COVID-19 may be yet another predisposing factor.

Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review

“…They are more observed in adult women, mainly caused by Escherichia coli ( 72 ). A single pediatric case of ECy pertains to a young girl aged 15 years admitted to the emergency department for abdominal and back pain and with a history of recurrent urinary tract infections and grade 1 left-sided vesicoureteral reflux: the swab for SARS-CoV-2 resulted positive and an HbA1c of 76 mmol/mol (9.1%) and blood glucose of 200 mg/dL were recorded, consistent with new-onset diabetes mellitus ( 73 ).…”