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Case Reports
. 2025 Sep 21;17(9):e92863.
doi: 10.7759/cureus.92863. eCollection 2025 Sep.

Emphysematous Cystitis in an Immunocompromised Patient With Ovarian Cancer: A Case Report

Kole Winebrenner  1 , Madeline Manuel  2 , John Greene  3
Affiliations
Case Reports

Emphysematous Cystitis in an Immunocompromised Patient With Ovarian Cancer: A Case Report

Kole Winebrenner et al. Cureus. .

Abstract

Emphysematous cystitis (EC) is a rare, potentially life-threatening infection characterized by gas formation within the bladder wall or lumen, most commonly caused by Escherichia coli or Klebsiella pneumoniae. It is typically associated with diabetes mellitus, immunosuppression, or urinary tract abnormalities. We present a case of EC in a 67-year-old immunocompromised female with advanced-stage ovarian cancer, undergoing chemotherapy with carboplatin and paclitaxel at the time of diagnosis. Her additional risk factors included diabetes mellitus and chronic corticosteroid use. Diagnosis was established via CT angiography, which revealed extensive gas within the bladder wall. Urine culture grew Klebsiella pneumoniae sensitive to ceftriaxone, which was administered intravenously. The patient was managed conservatively with antibiotics, bladder decompression, and supportive care, resulting in resolution of the infection. To our knowledge, this is the first reported case of EC in a patient receiving carboplatin and paclitaxel chemotherapy for ovarian cancer, underscoring the diagnostic complexity and management considerations of EC in oncology patients with compounding immunosuppressive risk factors.

Keywords: carboplatin; complicated urinary tract infection; conservative management; corticosteroid-induced immunosuppression; ct imaging diagnosis; emphysematous cystitis; klebsiella pneumoniae; opioid-induced urinary retention; ovarian cancer; pacitaxel.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Abdominal coronal CT angiography and abdominal X-ray – emphysematous cystitis.
(A) Coronal CT angiography of the abdomen and pelvis showing intramural bladder wall gas (red arrows) consistent with emphysematous cystitis. (B) Abdominal X-ray demonstrating mottled radiolucencies overlying the bladder (red arrows), corresponding to gas within the bladder wall. While X-ray can detect intramural air, its sensitivity and anatomical detail are inferior to CT.
Figure 2
Figure 2. Coronal CT angiography – emphysematous bladder wall gas.
Coronal CT angiography of the abdomen and pelvis demonstrating diffuse gas within the bladder wall (red arrows) without extension into the renal collecting system, thereby ruling out emphysematous pyelonephritis. The right ovary (yellow arrow) lies adjacent to the bladder wall with no evidence of fistula, abscess, or necrosis.
Figure 3
Figure 3. Sagittal and axial CT views of emphysematous cystitis.
(A) Sagittal CT angiography showing gas tracking circumferentially within the bladder wall. (B) Axial CT angiography confirming intramural gas throughout the bladder wall. No extraluminal extension or associated abscess is observed.
See this image and copyright information in PMC

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