Emphysematous Cystitis in a Patient With Type 2 Diabetes Treated With an SGLT2 Inhibitor: A Case Report

Abstract

A 92-year-old woman who had been diagnosed with diabetes three years previously and was taking canagliflozin for three months was admitted to our hospital because of fever and decreased blood pressure. Her blood pressure was 83/48 mmHg, and a laboratory examination showed a urinary tract infection, positive CRP, and renal dysfunction. Escherichia coli was detected in the urine and blood cultures. Abdominal computed tomography (CT) revealed air bubbles in the bladder wall. Based on these findings, the patient was diagnosed with septic shock accompanied by emphysematous cystitis. Her blood glucose level was 186 mg/dL and her HbA1c level was 6.5 %, indicating no worsening of glycemic control. The patient's condition improved with urethral drainage, fluid infusion, norepinephrine, and antibiotics. Emphysematous cystitis often occurs in elderly women with poorly controlled diabetes. However, in recent years, the increased use of SGLT2 inhibitors has been reported to be associated with emphysematous cystitis. Even elderly people with good blood glucose control may develop emphysematous cystitis when taking SGLT2 inhibitors.