Successful Conservative Management of Emphysematous Cystitis Following COVID-19 Infection

Emphysematous cystitis (EC) is a rare, potentially life-threatening urinary tract infection characterized by gas within the bladder wall or lumen due to gas-forming organisms. It most commonly occurs in patients with uncontrolled diabetes mellitus. Reports following COVID-19 remain limited. A 56-year-old male presented five weeks after recovery from COVID-19 pneumonia with fever, flank pain, and lower abdominal pain. Investigations revealed severe hyperglycemia, leukocytosis, and pyuria. CT of the kidneys, ureters, and bladder demonstrated intramural gas with anterior bladder wall dehiscence. Urine culture grew Enterococcus faecalis. The patient was managed conservatively with bladder drainage, glycemic control, and prolonged culture-directed antibiotics. Despite extensive disease, he remained clinically stable and showed complete recovery on follow-up imaging. This case highlights that conservative management can be successful even in extensive EC with bladder wall involvement in carefully selected, stable patients. The temporal association with COVID-19 is noted, but causality cannot be established.