Post-operative cystitis

A 72 year old male with diabetes mellitus was admitted with acute coronary syndrome and left ventricular failure. He was HIV-Positive and was adherent to anti-retroviral therapy (TDF/FTC/EFV) since past 8 years. A HIV viral load done 3 months earlier showed virologic suppression and the CD4 count was 635 cells/ul. He was diagnosed with triple-vessel coronary artery disease and underwent CABG.

On the 7th post-operative day, the patient developed mild dysuria and low grade fever. Urine microscopy showed innumerable leucocytes / hpf. ESBL producing E coli was isolated from urine cultures with a colony count > 10^5/ml. Blood cultures were sterile. A non-contrast CT showed bladder wall thickening with intramural air and perinephric stranding.

Emphysematous cystitis caused by ESBL producing E coli was diagnosed. The patient was started on IV ertapenem, continued for 2 weeks as outpatient IV therapy. On followup at 4 weeks, symptoms had resolved.

Refer: Another case report in NEJM

Emphysematous cystitis in diabetic HIV-positive individual