A case report of candidal cystitis

Introduction: Candidal cystitis is an uncommon fungal infection of the urinary bladder, predominantly caused by Candida albicans. It usually occurs in patients with predisposing factors such as uncontrolled diabetes mellitus, prolonged catheterization, immunosuppression, recent antibiotic therapy, or prior urological interventions. The clinical presentation often resembles bacterial cystitis, making diagnosis challenging. We report a rare case of candidal cystitis presenting with intravesical fungal balls that initially mimicked an enterovesical fistula on imaging. Case Report: A 63-year-old man with poorly controlled diabetes mellitus presented with severe dysuria and passage of thick urethral discharge. Initial ultrasonography was unremarkable; however, non-contrast computed tomography (CT) demonstrated air-containing debris-like lesions within the bladder, raising suspicion for an enterovesical fistula. Contrast-enhanced CT with oral contrast and delayed imaging excluded fistulous communication. Cystoscopy revealed multiple mushroom-shaped intravesical masses, diffuse erythematous bladder mucosa, and no evidence of a fistula. The fungal masses were evacuated, and urine culture confirmed C. albicans. The patient was diagnosed with candidal cystitis complicated by fungal balls secondary to uncontrolled diabetes. He underwent bladder irrigation with amphotericin B followed by oral fluconazole (150 mg twice daily for two weeks), resulting in complete clinical improvement and restoration of normal urinary flow. Conclusion: Candidal cystitis should be considered in diabetic patients presenting with persistent lower urinary tract symptoms and unusual intravesical imaging findings. Fungal balls may closely mimic enterovesical fistulas or bladder neoplasms, potentially leading to diagnostic confusion. Prompt recognition through urine culture and cystoscopy, combined with appropriate antifungal therapy and correction of underlying risk factors, can achieve excellent clinical outcomes while avoiding unnecessary interventions.