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Hemorrhagic cystitis and cytomegalic inclusions in the bladder associated with cyclophosphamide therapy

A case of severe hemorrhagic cystitis resulting from cyclophosphamide administration is presented. This complication is of import because it may lead to fatal hemorrhage if the etiology is unrecognized. The lesion appears to result from direct contact with urinary metabolites of the drug, although its lack of universal occurrence may indicate associated genetic or constitutional factors. Prompt discontinuation of the drug and conservative measures usually alleviate symptoms, but cystostomy with tamponade or urinary diversion may be required in cases of persistent bleeding. The resemblance of cyclophosphamide cystitis to changes produced by irradiation is noted. Although the major alterations occur within the lamina propria, atypical epithelial changes may be confused with carcinoma. A unique finding included the presence of cytomegalovirus inclusions in the bladder. It is possible that bladder damage was potentiated by this infection or that the injured bladder offered a site of preferential localization for the virus.