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.