Shingles infection causes man's bladder to burst in rare case

A man who developed a shingles infection around the base of his spine suffered from an unusual complication: His bladder ruptured.

According to a report of the case, published earlier this year in the journal Infection and Drug Resistance, the 77-year-old patient had been taking antiviral and pain-relieving medications for his shingles infection for a week before presenting to the emergency department. Shingles, or herpes zoster, is caused by the varicella-zoster virus, the same pathogen that causes chickenpox. After a chickenpox infection, the virus becomes dormant and hides in specific nerves. The virus can later be "reactivated" and cause shingles, which causes painful rashes of fluid-filled blisters.

In the four days prior to his hospital admission, the patient had difficulty emptying his bladder. Doctors at the hospital found his abdomen to be "distended and painful," particularly in the region below his stomach. In addition, his heart rate, blood pressure and breathing rate were all abnormally high.

A computed tomography (CT) scan of the man's abdomen revealed a large amount of fluid in his abdomen and pelvis, as well as a "suspected bladder breach." The man was moved to the intensive care unit, where he had a catheter placed; for three hours, bloody urine flowed continuously from his bladder. Having cleared the urine, the doctors could then examine the man's bladder for signs of rupture and found a nearly 0.8 inch (2 centimeter) tear in the organ.

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The team performed surgery to repair the man's bladder, and afterwards, he recovered in the hospital for several weeks while completing his shingles treatment. "The patient regained complete bladder function after undergoing surgery to repair the bladder and treatment with antiviral drugs," the team reported.

How could shingles cause someone's bladder to burst? In rare instances, the infection can cause urinary retention, where the bladder doesn't empty enough or at all when you urinate. The medical team ruled out other potential causes of urinary retention, such as an obstruction of the urinary tract or use of medications that could disrupt bladder function.

According to a report published in the journal Archives of Physical Medicine and Rehabilitation, this complication is relatively uncommon; at the medical center studied, it occurred in only 4% of shingles patients. However, in those who developed shingles around the lower spine and sacrum, the rate was much higher — around 28%. Depending on the patient, the complication seems to arise from either inflammation of the bladder, the nerves that plug into the bladder or the nearby nerves of the spinal cord. The inflammation ultimately disrupts the signals that tell the muscles of the bladder wall to contract. 

These muscle contractions are an involuntary reflex, and when that reflex malfunctions, the bladder ends up retaining urine rather than clearing it from the body. However, to the case report authors' knowledge, theirs is the first report of someone's bladder rupturing due to shingles-related urinary retention.

"The risk of herpes zoster-associated urinary system dysfunction cannot be ignored," the doctors wrote. "Urgent intervention is required for the acute urinary retention caused by herpes zoster infection in the sacral area."

In the man's case, a history of type 2 diabetes may have also contributed to his symptoms, the authors added . Because diabetes can cause nerve damage, those with the condition can lose some ability to sense when their bladders are full and to empty the organ completely, they wrote.