1700. A Rare Case of Candida glabrata Hemorrhagic Cystitis with Empagliflozin Use

BACKGROUND: Hemorrhagic cystitis is an inflammatory condition of the bladder, infrequently seen after cancer chemotherapy, pelvic radiation, and viral infections in immunocompromised hosts. METHODS: We report a case of biopsy-proven Candida glabrata hemorrhagic cystitis in an immunocompetent host associated with empagliflozin use. Empagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor, that increases urinary glucose excretion, and is associated with an increased risk of urogenital mycotic infections RESULTS: A 71-year-old man with a history type 2 diabetes, neurogenic bladder status post transurethral resection of the prostate, developed symptoms of pelvic pain and gross hematuria 3 months after the initiation of empagliflozin. The patient received multiple courses of empirical antibiotic therapy without any relief. Six months into the illness, the patient had significant weight loss, fatigue, progressive renal failure, and continued hematuria. Empagliflozin was self-discontinued by the patient secondary to a perceived relation between symptom onset and medication use. Urine cultures were negative. A CT scan showed mucosal thickening of the bladder wall with hydronephrosis. Cystoscopy was consistent with hemorrhagic cystitis. A bladder biopsy was negative for malignancy, stain and PCR negative for fungi, but culture positive for C. glabrata susceptible to Fluconazole. Mycobacterial stains, cultures, and PCR were negative. The patient was treated with Fluconazole for 4 weeks and experienced symptomatic improvement and resolution of hematuria one week into the therapy. CONCLUSION: This is the first reported case of C. glabrata hemorrhagic cystitis in an immunocompetent host associated with empagliflozin. Invasive candida infections in the genitourinary system are rare in immunocompetent patients. We believe that empagliflozin-induced glycosuria may have been a predisposing factor. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.