ADENOVIRUS-INDUCED HEMORRHAGIC CYSTITIS IN A PEDIATRIC ONCOLOGY PATIENT WITH ARDS

Spanaki AM*, Hantzara M*, Katsanoulas C*, Chatzimichali A*, Smyrnaki P^, Stiakaki E^, Kalmanti M^

* PICU,^Pediatric Henatology Oncology Dept, University Hospital of Heraklion,Crete, Greece

 

Objective: Hemorrhagic cystitis(HC) results from bladder transitional epithelium and blood vessels damage by toxins, viruses,irradiation,drugs or disease. The cause of HC is often difficult to be determined because forced hydration or intravesical saline irrigation,used to treat this disease,precludes adequate urine collection for bacterial and viral cultures.In pediatric oncology patients HC,if severe, may be a life threatening complication.

Method: We describe the case of a 3,5 years old girl with a brain tumor(IV ventricle ependymoma),who was admitted in our PICU with a severe ARDS, associated, 3 weeks later,with severe HC.She was already hospitalized in Pediatr.Oncology department for 2 weeks with a febrile lower respiratory system infection. Concerning the main disease she underwent autologous bone marrow transplantation one year before and radiation therapy five months ago. In our unit she was given a broad-spectrum antibiotic treatment against bacteria,Pneumonocystis Carinii,fungus and CMV virus. Therapeutic management of HC consisted of hyperhydration, forced diuresis and intravesical saline irrigation through a large bore urethral catheter, all insufficient to control hemorrhage. She was also platelet and RBC transfused. At last, hemorrhage stopped after a cystoscopic cauterization.

Results: Initial routine cultures and serological results failed to reveal the exact etiological agent (tests not included ADV). Thrombocytes and blood clotting were normal. Specific antibodies for adenovirus were asked, 3 weeks later, in two consecutive blood samples within a week. The suspicion of an ADV-induced respiratory infection and HC was confirmed with the serological results. Urinary bladder histopathological examination (through cystoscopy) revealed an inflammatory, non-malignant mass. Urine culture was positive for ADV presence.

Conclusion: ADV should be considered in the differential diagnosis of HC, especially when accompanied with respiratory system infection, in immunocompromised patients.

 
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