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

Emphysematous cystitis (EC) is a rare, gas-forming bladder wall infection, most commonly caused by <i>Escherichia coli</i> <i>(E. coli)</i> 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 <i>Pseudomonas aeruginosa (P. aeruginosa)</i>. She was treated with extended antibiotic therapy, leading to stabilization of the osteomyelitis. This report highlights the unusual role of <i>P. aeruginosa</i>, 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 <i>Klebsiella pneumoniae (K. pneumoniae),</i> 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.