Urogenit Tract Infect.  2017 Dec;12(3):130-133. 10.14777/uti.2017.12.3.130.

Emphysematous Cystitis Combined with Prostatic Abscess and Hematogenous Spread of Infection to the Lung and Liver in a Diabetic Patient

• Lee J
• Rhee H
• Kim IY
• Seong EY
• Lee DW
• Lee SB
• Kwak IS
• Song SH

• KMID: 2400222
• DOI: http://doi.org/10.14777/uti.2017.12.3.130

Abstract

Coexistence of emphysematous cystitis and prostatic abscess are rare occurrences. Here, we report a case of emphysematous cystitis and prostatic abscess in a 65-year-old man with a 5-year history of diabetes mellitus. This case was further complicated by the hematogenous spread of Klebsiella pneumoniae infection from the prostatic abscess to the liver and lung. Computed tomography (CT) imaging revealed a localized gas within the urinary bladder and swelling of the prostate, with fluid accumulation. Multiple low-density lesions were observed in liver segments S3, S4, and S7, suggestive of an inflammatory process. Chest CT scan revealed multiple cavitatory nodules of various sizes, with a ground glass appearance of both lung fields, which suggest septic emboli from severe uro-septicemia. The optimal antibiotic therapy was administered, and a holmium laser enucleation of the prostate operation was subsequently performed. On day 37 post-admission, the patient was discharged in a good condition, without any sequelae.

Keyword

Prostatic abscess; Emphysematous cystitis; Septic emboli

MeSH Terms

Abscess*
Aged
Cystitis*
Diabetes Mellitus
Glass
Humans
Klebsiella pneumoniae
Lasers, Solid-State
Liver*
Lung*
Prostate
Tomography, X-Ray Computed
Urinary Bladder

Figure

• 

  Fig. 1 (A) Distended urinary bladder with intraluminal and intramural gas collection. (B) Swelling of the prostate gland, with fluid accumulation. (C) Ill-defined low-density lesions in sections S3, S4, and S7 of the liver. (D) Multiple cavitatory nodules of various sizes with a ground glass appearance of both lung fields.

• 

  Fig. 2 (A) Interval improvement of emphysematous cystitis. (B) Decreased prostatic abscess size.

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