Emphysematous cystitis, iliopsoas abscess, and pneumorrhachis in an elderly woman: a case report.
Case report
Emphysematous cystitis
Gangrene
Iliopsoas abscess
Pneumorrhachis
Sepsis
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
10 Apr 2023
10 Apr 2023
Historique:
received:
02
08
2021
accepted:
27
02
2023
medline:
11
4
2023
entrez:
9
4
2023
pubmed:
10
4
2023
Statut:
epublish
Résumé
Emphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis. This is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock. Our case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.
Sections du résumé
BACKGROUND
BACKGROUND
Emphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis.
CASE PRESENTATION
METHODS
This is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock.
CONCLUSIONS
CONCLUSIONS
Our case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.
Identifiants
pubmed: 37032335
doi: 10.1186/s13256-023-03856-7
pii: 10.1186/s13256-023-03856-7
pmc: PMC10084606
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
150Informations de copyright
© 2023. The Author(s).
Références
Eur Spine J. 2006 Oct;15 Suppl 5:636-43
pubmed: 16835735
BJU Int. 2007 Jul;100(1):17-20
pubmed: 17506870
Am J Med Sci. 2007 Feb;333(2):111-6
pubmed: 17301591
Emerg Radiol. 2009 Mar;16(2):151-4
pubmed: 18351407
Int Urol Nephrol. 2021 Jan;53(1):91-92
pubmed: 32778996
Int J Infect Dis. 2016 Oct;51:105-106
pubmed: 27637417
Clin Case Rep. 2020 May 28;8(9):1686-1688
pubmed: 32983477
J Trauma. 2010 Mar;68(3):736-44
pubmed: 20220428
Diabet Med. 2001 Jan;18(1):68-71
pubmed: 11168344
Neurology. 1994 Dec;44(12):2409-10
pubmed: 7991142