Emphysematous Cystitis With Extraperitoneal Bladder Perforation in a Frail Elderly Patient on Long-Term Corticosteroid Therapy Without Diabetes: A Hidden Geriatric Threat in a Frail Elderly Patient.

Emphysematous cystitis is a rare but serious urinary tract infection characterized by gas formation within and around the bladder wall, affecting elderly immunocompromised patients. The case report describes an 82-year-old frail gentleman admitted to a geriatric ward with nonspecific symptoms, including malaise, later diagnosed with emphysematous cystitis complicated by bladder perforation. The case is unusual due to the absence of classic urinary symptoms, chronically elevated C-reactive protein (CRP) with emphysematous cystitis presenting insidiously in a frail elderly patient on long-term high-dose corticosteroids. Diabetes mellitus is the most frequently reported risk factor; however, other forms of immunosuppression remain under-recognised. Management involved a multidisciplinary team approach with early antibiotic therapy, urology and microbiology input, and careful monitoring, resulting in improvement and resolution of bladder pathology. This case highlights the importance of maintaining a broad differential diagnosis in frail older adults with multiple comorbidities and immunosuppression and reinforces the importance of timely diagnostics and comprehensive geriatric assessments.