Spontaneous perforation of urinary bladder secondary to Candida cystitis: acute abdomen of urologic origin.
BACKGROUND
Spontaneous urinary bladder perforation is a rare event; presentation as an acute abdomen is rarer still. Fungal cystitis has seldom, and Candida albicans cystitis has never, to our knowledge, been reported as a cause of perforation.


METHODS
Case report and literature review.


RESULTS
A 70-year-old woman with diabetes mellitus presented with an acute abdomen and urinary symptoms. A diagnosis of an intraperitoneal bladder perforation was made during emergency operation; culture of the peritoneal fluid and urine yielded Candida albicans. The initial high blood urea nitrogen and serum creatinine concentrations mimicked acute renal failure but were caused by urine absorption across the peritoneum. The patient was treated successfully with emergency laparotomy, a three-week course of fluconazole, and a five-day course of bladder irrigation with amphotericin B.


CONCLUSIONS
Spontaneous urinary bladder perforation secondary to Candida cystitis should be considered as a possible cause of acute abdomen, especially when the biochemical profile suggests urine absorption and yeast is reported in the urinalysis of an immunocompromised patient.
Mardani
Masoud
M
Infectious Diseases and Tropical Medicine Research Center, Shaheed Beheshti University (M.C.), Tehran, Iran.
Shahzadi
Mohammadreza
M
Rakhshani
Nasser
N
Rahnavardi
Mohammad
M
Rezvani
Javad
J
Sharifinejad
Abbas
A
D000006:Abdomen, Acute / Q000209:etiology*; D000368:Aged; D002176:Candida albicans / Q000302:isolation & purification*; D002177:Candidiasis / Q000150:complications* / Q000382:microbiology; D003556:Cystitis / Q000150:complications* / Q000382:microbiology; D005260:Female; D006801:Humans; D012422:Rupture, Spontaneous; D001743:Urinary Bladder; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000209:etiology*