Scientific Letter
Emphysematous Cystitis and Infectious Exacerbation of COPD. A Highly Unusual Finding
Cistitis enfisematosa y agudización infecciosa de la EPOC. Un hallazgo altamente infrecuente
David P. Rodríguez Lópeza,
, Nuria Marina Malandab, Idoia Salinas Garridoc, Juan B. Gáldiz Iturrib,d,e
Corresponding author
a Neumología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
b Sección Unidad de Asma, Laboratorio de Exploración Funcional, Departamento de Neumología, Hospital Universitario Cruces, BioCruces, Barakaldo, Bizkaia, Spain
c Neumología, Hospital Universitario Cruces, BioCruces, Barakaldo, Bizkaia, Spain
d Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
e Universidad del País Vasco (UPV-EHU), Leioa, Bizkaia, Spain
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"apellidos" => "Gáldiz Iturri" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Neumología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección Unidad de Asma, Laboratorio de Exploración Funcional, Departamento de Neumología, Hospital Universitario Cruces, BioCruces, Barakaldo, Bizkaia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Neumología, Hospital Universitario Cruces, BioCruces, Barakaldo, Bizkaia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Universidad del País Vasco (UPV-EHU), Leioa, Bizkaia, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cistitis enfisematosa y agudización infecciosa de la EPOC. Un hallazgo altamente infrecuente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 661 "Ancho" => 850 "Tamanyo" => 55809 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography showing gas in the bladder and the bladder wall.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Emphysematous cystitis (EC) is an uncommon complication of urinary tract infection, defined by the presence of gas in the bladder and/or bladder walls.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> It mainly affects elderly women with diabetes mellitus, poor blood glucose control, and a history of bladder catheterization. Other factors, while less important, may also be associated with this disease, such as renal transplantation, immunosuppression, and recurrent urinary tract infections.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The most commonly isolated causative pathogens on urine culture are <span class="elsevierStyleItalic">Escherichia coli</span>, <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> and <span class="elsevierStyleItalic">Enterococcus</span>.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Clinical presentation is non-specific but most patients present urinary symptoms and abdominal pain. Pneumaturia is a key but infrequent pointer to suspecting EC.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> For diagnosis, standard radiography of the urinary tract is unspecific, and the superior resolution and greater ability of computed tomography (CT) to rule out other causes of EC, such as enterovesical fistula due an inflammatory or malignant process, make it the examination of choice.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Initial treatment consists of empirical antibiotics, intensive metabolic control, and urinary diversion (transurethral catheterization or bladder drainage).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The clinical response of patients varies from rapid clinical improvement to general deterioration with a high rate of complications, such as emphysematous pyelonephritis, bladder perforation, septic shock, and rapid death.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the unusual case of a male patient, non-diabetic, with normal blood glucose levels and no significant urological history, who presented EC during admission to the pulmonology ward for a severe COPD exacerbation caused by infection. <span class="elsevierStyleItalic">E. coli</span> was cultured from both sputum and urine samples. Our patient was a 66-year-old man, retired from employment in an iron foundry, who had given up smoking 5 years previously (70 pack-years). He had a history of childhood tuberculosis, arterial hypertension, moderate COPD, non-exacerbator emphysematous phenotype (GOLD category A) and, 5 years previously, community-acquired pneumonia. He reported a 5-day history of clinical symptoms of infection, with rhinorrhea, increased cough with purulent sputum, dyspnea, and fever 38.3<span class="elsevierStyleHsp" style=""></span>°C. He had no urinary symptoms and no changes in bowel habits. He also showed overall acute respiratory failure, with left-shift leukocytosis and increased PCR on clinical laboratory tests. Blood glucose was normal. Urine antigen testing for pneumococci and <span class="elsevierStyleItalic">Legionella</span> and sputum culture were performed, which were negative. The physical examination showed significant deterioration of the patient's general status, with tachypnea, and disperse rhonchi on lung auscultation. No signs of abdominal disease were observed at that time.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On day 3 of admission, the patient's clinical situation deteriorated, with symptoms of urinary infection (tenesmus, dysuria, and hematuria). An examination of urinary sediment was requested, showing abundant red blood cells per field and positive nitrites. Gram-negative antibiotic cover was administered, and urine culture was requested, which was positive for <span class="elsevierStyleItalic">E. coli</span>, so piperacillin–tazobactam was given, in line with the microbiological sensitivity results. A chest-abdominal computed tomography was performed to complete the study, revealing gas in the bladder lumen, infiltrating the walls (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). After diagnosing EC, and following consultations with the urology department, we introduced a bladder catheter, obtaining 400<span class="elsevierStyleHsp" style=""></span>ml of urine with a slightly hematic tinge and abundant air. Intravenous piperacillin–tazobactam was also initiated and continued for 15 days. The urine culture was repeated after the antibiotic cycle, and results were negative. The bladder catheter was removed and the patient's abdominal symptoms resolved. Despite the initial improvement, respiratory symptoms persisted with purulent expectoration, and a repeat sputum culture was again positive for <span class="elsevierStyleItalic">E. coli</span> that showed intermediate sensitivity to piperacillin–tazobactam, so antibiotic therapy was switched to intravenous meropenem. The patient finally showed satisfactory progress, and after completing the intravenous treatment regiment, he was discharged with subsequent follow-up by the respiratory medicine department.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez López DP, Marina Malanda N, Salinas Garrido I, Gáldiz Iturri JB. Cistitis enfisematosa y agudización infecciosa de la EPOC. Un hallazgo altamente infrecuente. Arch Bronconeumol. 2017;53:406–407.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 661 "Ancho" => 850 "Tamanyo" => 55809 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography showing gas in the bladder and the bladder wall.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emphysematous cystitis and pyelitis in a diabetic renal transplant recipient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Akalin" 1 => "C. Hyde" 2 => "G. Schmitt" 3 => "J. Kaufman" 4 => "R.J. Hamburger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Tansplantation" "fecha" => "1996" "volumen" => "62" "paginaInicial" => "1024" "paginaFinal" => "1026" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emphysematous cystitis: a review of the spectrum of disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.J. Quint" 1 => "G.W. Drach" 2 => "W.D. Rappaport" 3 => "C.J. Hoffmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "1992" "volumen" => "147" "paginaInicial" => "134" "paginaFinal" => "137" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1729506" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pneumaturia due to gas-producing <span class="elsevierStyleItalic">E. coli</span> and urinary stasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.M. Ho" 1 => "M. Sole" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Urol" "fecha" => "1994" "volumen" => "73" "paginaInicial" => "588" "paginaFinal" => "589" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8012788" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emphysematous infections of the abdomen and pelvis: a pictorial review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.E. Grayson" 1 => "R.M. Abbott" 2 => "A.D. Levy" 3 => "P.M. Sherman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiographics.22.3.g02ma06543" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2002" "volumen" => "22" "paginaInicial" => "543" "paginaFinal" => "561" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12006686" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cistitis enfisematosa clásica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Vilchis-Cárdenas" 1 => "A.A. Grimaldo-Oliveros" 2 => "J.A. Ibáñez-Marín" 3 => "M.A. Feria-Flores" 4 => "M.A. García Rodríguez" 5 => "A. Peña-Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Mex Urol" "fecha" => "2010" "volumen" => "70" "paginaInicial" => "376" "paginaFinal" => "379" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgements" "texto" => "<p id="par0020" class="elsevierStylePara elsevierViewall">Our thanks to the Functional Examination Laboratory of the Hospital Universitario Cruces.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917301830/v1_201706290145/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000007/v1_201706290145/S1579212917301830/v1_201706290145/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301830?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 3 | 16 |
| 2024 October | 74 | 13 | 87 |
| 2024 September | 80 | 13 | 93 |
| 2024 August | 91 | 44 | 135 |
| 2024 July | 65 | 27 | 92 |
| 2024 June | 74 | 26 | 100 |
| 2024 May | 95 | 27 | 122 |
| 2024 April | 76 | 28 | 104 |
| 2024 March | 63 | 21 | 84 |
| 2024 February | 44 | 20 | 64 |
| 2023 March | 13 | 5 | 18 |
| 2023 February | 68 | 16 | 84 |
| 2023 January | 45 | 22 | 67 |
| 2022 December | 67 | 25 | 92 |
| 2022 November | 75 | 20 | 95 |
| 2022 October | 89 | 36 | 125 |
| 2022 September | 69 | 28 | 97 |
| 2022 August | 84 | 47 | 131 |
| 2022 July | 50 | 43 | 93 |
| 2022 June | 44 | 43 | 87 |
| 2022 May | 55 | 36 | 91 |
| 2022 April | 74 | 36 | 110 |
| 2022 March | 51 | 40 | 91 |
| 2022 February | 90 | 24 | 114 |
| 2022 January | 92 | 46 | 138 |
| 2021 December | 78 | 43 | 121 |
| 2021 November | 53 | 41 | 94 |
| 2021 October | 56 | 44 | 100 |
| 2021 September | 79 | 44 | 123 |
| 2021 August | 63 | 42 | 105 |
| 2021 July | 67 | 32 | 99 |
| 2021 June | 51 | 27 | 78 |
| 2021 May | 65 | 39 | 104 |
| 2021 April | 175 | 119 | 294 |
| 2021 March | 89 | 43 | 132 |
| 2021 February | 40 | 27 | 67 |
| 2021 January | 49 | 12 | 61 |
| 2020 December | 58 | 25 | 83 |
| 2020 November | 41 | 10 | 51 |
| 2020 October | 60 | 27 | 87 |
| 2020 September | 57 | 11 | 68 |
| 2020 August | 46 | 21 | 67 |
| 2020 July | 68 | 22 | 90 |
| 2020 June | 67 | 4 | 71 |
| 2020 May | 65 | 10 | 75 |
| 2020 April | 58 | 25 | 83 |
| 2020 March | 37 | 6 | 43 |
| 2020 February | 34 | 15 | 49 |
| 2020 January | 56 | 19 | 75 |
| 2019 December | 49 | 20 | 69 |
| 2019 November | 40 | 35 | 75 |
| 2019 October | 33 | 16 | 49 |
| 2019 September | 59 | 12 | 71 |
| 2019 August | 43 | 17 | 60 |
| 2019 July | 278 | 16 | 294 |
| 2019 June | 31 | 11 | 42 |
| 2019 May | 43 | 15 | 58 |
| 2019 April | 65 | 20 | 85 |
| 2019 March | 44 | 16 | 60 |
| 2019 February | 33 | 11 | 44 |
| 2019 January | 21 | 9 | 30 |
| 2018 December | 25 | 11 | 36 |
| 2018 November | 74 | 26 | 100 |
| 2018 October | 121 | 38 | 159 |
| 2018 September | 49 | 14 | 63 |
| 2018 May | 29 | 2 | 31 |
| 2018 April | 23 | 2 | 25 |
| 2018 March | 69 | 6 | 75 |
| 2018 February | 65 | 9 | 74 |
| 2018 January | 132 | 8 | 140 |
| 2017 December | 132 | 7 | 139 |
| 2017 November | 40 | 5 | 45 |
| 2017 October | 31 | 10 | 41 |
| 2017 September | 2 | 1 | 3 |
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