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Neurological Rehabilitation

Sepsis Following Intradetrusor Botulinum Toxin A Injection in an Adolescent with Neurogenic Bladder: A Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 5
Disclosure(s):
Emma W. Singleton, Other: No financial relationships to disclose
Kevin Park, MD: No financial relationships to disclose
Case Diagnosis: A 16-year-old male with C6 AIS B spinal cord injury developed E. coli UTI, bacteremia, and sepsis after intradetrusor botulinum toxin A (BoTA) injection for neurogenic bladder (NB).

Case Description or Program Description: The patient underwent cystoscopy and BoTA injection after an inadequate response to anticholinergics. A total of 200 units were injected into 10 sites. By post-procedure day 4, he developed hypotension, tachycardia, hematuria, and suprapubic pain, progressing to severe sepsis with leukopenia (0.59), lactic acidosis (3.8), and acute kidney injury (Cr 1.14). Transferred to the MICU, he was diagnosed with E. coli bacteremia, required vasopressors, and was treated with cefepime and vancomycin. On MICU day 3, he developed disseminated intravascular coagulation (DIC) but stabilized with supportive care and transitioned to ceftriaxone.

Setting: Tertiary care rehabilitation hospital

Assessment/Results: The patient recovered and returned to rehabilitation on MICU day 8 before discharging home. He resumed intermittent catheterization with occasional overflow incontinence and declined further BoTA injections.

Discussion (relevance): To our knowledge, this is the first reported case of urosepsis following intradetrusor BoTA injection for NB. Urosepsis has been reported post-cystoscopy in patients with concurrent UTI [1]. We propose that asymptomatic bacteriuria or chronic colonization introduced bacteria into the bloodstream. Antibiotic prophylaxis guidelines remain unclear for these patients, balancing infection risk with antimicrobial resistance. No pre-procedure urinalysis was obtained, and prophylactic antibiotics were not administered.

Conclusions: Urosepsis is a potential life-threatening complication of BoTA injection, particularly in patients with bacteriuria or chronic colonization. Screening for bacteriuria and considering prophylactic antibiotics before BoTA injection may mitigate risk.

1. Bavetta S. et al. Spreading sepsis by cystoscopy. Postgrad Med J. 1990 Sep;66(779):734-5. PMID: 2235806.