# An Atypical Case of Concurrent Emphysematous Cystitis and Osteomyelitis in a Patient With Metastatic Cancer

## TL;DR

A rare case of bladder infection with gas and bone infection in a cancer patient is reported, highlighting unusual bacteria and the importance of early diagnosis.

## Contribution

The paper presents an atypical case of emphysematous cystitis caused by Pseudomonas aeruginosa in a metastatic cancer patient.

## Key findings

- Emphysematous cystitis and osteomyelitis were diagnosed in a breast cancer patient undergoing chemotherapy.
- Pseudomonas aeruginosa was identified as the causative agent, which is less commonly associated with emphysematous cystitis.
- Extended antibiotic therapy stabilized the osteomyelitis, emphasizing the need for prompt diagnosis and treatment.

## Abstract

Emphysematous cystitis (EC) is a rare, gas-forming bladder wall infection, most commonly caused by Escherichia coli (E. coli) and typically seen in diabetic or immunocompromised patients. We report a case of a 50-year-old female with breast cancer undergoing neoadjuvant chemotherapy who presented with hematuria, nausea, and vomiting. Imaging and laboratory workup revealed EC and concurrent osteomyelitis caused by Pseudomonas aeruginosa (P. aeruginosa). She was treated with extended antibiotic therapy, leading to stabilization of the osteomyelitis. This report highlights the unusual role of P. aeruginosa, a less common gas-producing organism, in the pathogenesis of EC. We also review two additional cases of EC in oncology patients undergoing chemotherapy, with the underlying microbe being Klebsiella pneumoniae (K. pneumoniae), and treated with appropriate antibiotics. These cases further emphasize the significance of EC in patients with metastatic cancer undergoing chemotherapy to prompt early investigation and guide treatment.