Spontaneous perforation of urinary bladder secondary to Candida cystitis: acute abdomen of urologic origin

Abstract

Background: Spontaneous urinary bladder perforation is a rare event; presentation as an acute abdomen is rarer still. Fungal cystitis has seldom, and Candida albicans cystitis has never, to our knowledge, been reported as a cause of perforation.

Methods: Case report and literature review.

Results: A 70-year-old woman with diabetes mellitus presented with an acute abdomen and urinary symptoms. A diagnosis of an intraperitoneal bladder perforation was made during emergency operation; culture of the peritoneal fluid and urine yielded Candida albicans. The initial high blood urea nitrogen and serum creatinine concentrations mimicked acute renal failure but were caused by urine absorption across the peritoneum. The patient was treated successfully with emergency laparotomy, a three-week course of fluconazole, and a five-day course of bladder irrigation with amphotericin B.

Conclusions: Spontaneous urinary bladder perforation secondary to Candida cystitis should be considered as a possible cause of acute abdomen, especially when the biochemical profile suggests urine absorption and yeast is reported in the urinalysis of an immunocompromised patient.