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Case Report
A case report of candidal cystitis
1 Urology Specialist, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 MD, Renal Transplant Surgery Fellowship, Department of Urology, Hashemnejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
3 Assistant professor of Urology, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Address correspondence to:
Farhad Ahmadi
Urology Specialist, Shahid Sadoughi University of Medical Sciences, Yazd,
Iran
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Article ID: 100067Z15FA2026
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Ahmadi F, Zolfi E, Saffari H, Abian N. A case report of candidal cystitis. J Case Rep Images Urol 2026;11(2):1–6.ABSTRACT
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.
Keywords: Candida, Cystitis, Diabetes mellitus, Fungal ball
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Farhad Ahmadi - Conception of the work, Design of the work, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ehsan Zolfi - Acquisition of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Hossein Saffari - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Nasrollah Abian - Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2026 Farhad Ahmadi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
