Emphysematous cystitis with bilateral pyelonephritis in a pediatric patient with COVID-19

• Published in: BMJ case reports Vol. 15; no. 2; p. e245779
• Main Authors: Cao, Brent Liu, Brewer, Owen, Cross, Adam R
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 03-02-2022; BMJ Publishing Group
• Subjects: Abscesses; Adolescent; Antibiotics; Bladder; Case Report; Case reports; Child; Coronaviruses; COVID-19; Cystitis - complications; Cystitis - diagnostic imaging; Cystitis - drug therapy; Diabetes; E coli; Emphysema - diagnostic imaging; Female; Glucose; Humans; Inflammation; Medical imaging; Pain; Pathogenesis; Patients; Pediatrics; Pyelonephritis - complications; Pyelonephritis - diagnostic imaging; Pyelonephritis - drug therapy; Risk factors; SARS-CoV-2; Teenagers; Ultrasonic imaging; Urinary tract diseases; Urinary tract infections; Urine; Urogenital system; Urology; COVID-19; gas/free gas; urinary tract infections
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-245779

A 15-year-old female adolescent with a medical history of recurrent urinary tract infections and grade 1 left-sided vesicoureteral reflux presented to the emergency room with abdominal and back pain. Labs revealed a haemoglobin A1c (HbA1c) of 9.1% and a random blood glucose of 200 mg/dL, consistent with new-onset diabetes mellitus. Nasopharyngeal COVID-19 PCR test returned positive. A CT scan of the abdomen and pelvis revealed bilateral attenuation of the kidneys and air in the bladder, which was confirmed by pelvic ultrasound. Gas subsequently resolved 2 days later after treatment with antibiotics, and a diagnosis of emphysematous cystitis was made. Emphysematous cystitis in the paediatric population is an extremely rare condition with four cases reported in the literature. Furthermore, there has been a reported association between COVID-19, cystitis and non-typical course of urinary symptoms. Local inflammation obstructing transportation of formed gas is one of the proposed mechanisms underlying emphysematous cystitis, and so COVID-19 may be yet another predisposing factor.