A Case of Emphysematous Cystitis with Lung Cancer at the End Stage

ABSTRACT

Introduction: We report on a patient with end-stage lung cancer who developed the relatively rare condition of emphysematous cystitis. Case A 72-year-old man was diagnosed with carcinomatous meningitis while being treated for lung cancer and bone metastasis. Anticancer therapy was terminated, and he was transferred to our palliative care unit. During the transfer, he exhibited progressively impaired consciousness and bilateral leg paralysis. Imaging studies performed to assess his medical state revealed intrathecal nodes associated with carcinomatous meningitis and emphysema in the bladder wall. Emphysematous cystitis was diagnosed. The bladder was irrigated and drained, and antibiotic therapy was administered. Although the bladder wall emphysema resolved, the patient died of progression of carcinomatous meningitis on the 10th day after transfer. Discussion: The development of emphysematous cystitis is reported to be likely in patients with underlying diseases, such as malignant tumor, diabetes mellitus, and neurogenic bladder, as well as in those with a history of steroid use. Our patient also exhibited many risk factors, including a history of steroid use and bladder and rectal disturbance due to carcinomatous meningitis, in addition to cancer. In end-stage cancer patients, the risk of developing emphysematous cystitis is expected to be higher than in normal persons because they have often used steroids for malaise, anorexia, and other conditions, and exhibit metastasis to the central nervous system, drug-induced dysuria, and other complications. Caution should be exercised in end-stage cancer patients to recognize emphysematous cystitis, which can be life-threatening in some cases.