Emphysematous Cystitis Occurred in the Case Treated with Steroid for Autoimmune Hepatitis

Emphysematous cystitis is a rare clinically entity, more commonly seen in diabetic, immunocompromised patients, which was characterized by air within the bladder wall and lumen. A 83-year-old woman was introduced to our department with fever elevation and abnormal findings of computed tomography (CT). She took orally prednisolone for autoimmune hepatitis. Pelvic CT revealed diffuse air throughout the bladder wall. Urinalysis showed combined hematuria and pyuria. Escherichia coli was detected in blood culture. Abnormal findings of complete blood count and laboratory examination included an elevated WBC count (12,200/ L), C-reactive protein (11.7？mg/dL), and creatinine (1.07？mg/dL). Cystoscopy confirmed diffuse submucosal emphysema throughout. On the basis of diagnosis with emphysematous cystitis, she was treated with antibiotics based on the results of blood culture and indwelling Foley catheter. After treatment, the improvement of inflammatory findings and submucosal emphysema on cystoscopy and CT were achieved. 1. Introduction Air within the urinary tract can occur because of instrumentation, fistula, tissue infarction with necrosis, or infection. Gas-forming infections of the urinary tract, such as emphysematous cystitis and emphysematous pyelonephritis, are uncommon but potentially life threatening. Therefore, prompt diagnosis and treatment are warranted to prevent the potential morbidity and mortality of this infectious condition. Emphysematous cystitis is a lower urinary tract infection (UTI) characterized by air within the bladder wall and lumen. 10% of cases of emphysematous cystitis required surgical intervention, including cystectomy or partial cystectomy, whereas the remaining cases were managed with a combination of antibiotics, bladder drainage, and tight glycemic control [1]. The overall death rate of emphysematous cystitis was 7%. In this report, we present a case of emphysematous cystitis treated with medical management. 2. Case Report A 83-year-old woman was introduced to our department with fever elevation and abnormal findings of computed tomography (CT). She was in our hospital due to autoimmune hepatitis, liver cirrhosis, and ascites. She took orally diuretics, antihypertensive, isosorbide mononitrate, and proton pump inhibitor (PPI) as addiction medicine. In addition, prednisolone was administered at an initial dose of？？20？mg/day and tapered for the past one month. There was no history of urinary symptoms and UTI. The results of physical examination were unremarkable. Pelvic CT revealed diffuse air throughout the bladder wall