The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Intravesical Cidofovir in the Treatment of Hemorrhagic Cystitis after Unrelated Cord Blood Transplantation

제대혈이식 후 발생한 바이러스성 출혈성 방광염의 방광내 약물 주입치료

  • Yoon, Harry (Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kim, Jo-Eun (Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Park, Ji-Soo (Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Lee, Jeong-Guil (Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Shin, Dae-Kyu (Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Oh, Do-Yeun (Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Chong, So-Young (Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine)
  • 윤해리 (CHA 의과학대학교 내과학교실) ;
  • 김조은 (CHA 의과학대학교 내과학교실) ;
  • 박지수 (CHA 의과학대학교 내과학교실) ;
  • 이정길 (CHA 의과학대학교 내과학교실) ;
  • 신대규 (CHA 의과학대학교 내과학교실) ;
  • 오도연 (CHA 의과학대학교 내과학교실) ;
  • 정소영 (CHA 의과학대학교 내과학교실)
  • Published : 2011.11.01
⟨ Previous Next ⟩

Abstract

Hemorrhagic cystitis is a common complication in hematopoietic stem cell transplant recipients. We report a case of hemorrhagic cystitis after unrelated cord blood transplantation associated with adenovirus infection. Despite hydration, hematuria and large clots persisted. We instilled cidofovir into the bladder, which resulted in clearance of the adenovirus and significant clinical improvement. Our case emphasizes the effectiveness of intravesical cidofovir treatment for viral hemorrhagic cystitis.

조혈모세포이식 후 발생한 출혈성 방광염 환자에게 있어 바이러스뇨증이 흔하게 발견되며 그 중에서도 특히 아데노바이러스, BK바이러스가 관련되어 있다고 알려져 있다. 따라서 cidofovir 등의 항바이러스제가 치료에 중요한 비중을 차지하고 있다. 그러나 cidofovir의 정맥주입은 알려진 대로 신독성 등을 초래할 수 있어 주의를 요한다. 본 증례는 제대혈이식 후 바이러스 감염으로 인해 발생한 출혈성 방광염에 일차 항바이러스치료로 cidofovir를 방광내 주입하였으며 신기능 악화 소견없이 임상적 호전 및 바이러스 제거 효과를 보여 보고하는 바이며 정맥내 cidofovir 주입의 대안이 될 수 있을 것으로 생각된다.

Keywords

References

  1. Oh SH, Kim HJ, Park SA, et al. A case of acute hyponatremia after administering cyclophosphamide as conditioning regimen for allogeneic stem cell transplantation. Korean J Med 2008;75: 798-800.
  2. Miyamura K, Takeyama K, Kojima S, et al. Hemorrhagic cystitis associated with urinary excretion of adenovirus type 11 following allogeneic bone marrow transplantation. Bone Marrow Transplant 1989;4:533-535.
  3. Focosi D, Maggi F, Pistolesi D, et al. Hyperbaric oxygen therapy in BKV-associated hemorrhagic cystitis refractory to intravenous and intravesical cidofovir: case report and review of literature. Leuk Res 2009;33:556-560. https://doi.org/10.1016/j.leukres.2008.06.018
  4. Fanourgiakis P, Georgala A, Vekemans M, et al. Intravesical instillation of cidofovir in the treatment of hemorrhagic cystitis caused by adenovirus type 11 in a bone marrow transplant recipient. Clin Infect Dis 2005;40:199-201. https://doi.org/10.1086/426594
  5. Tomonari A, Takahashi S, Ooi J, et al. Hemorrhagic cystitis in adults after unrelated cord blood transplantation: a singleinstitution experience in Japan. Int J Hematol 2006;84:268-271. https://doi.org/10.1532/IJH97.05169
  6. Shin HJ, Park CY, Park YH, et al. Risk factors of hemorrhagic cystitis after hematopoietic stem cell transplantation. Korean J Med 2001;61Suppl:S151-S152.
  7. Nagafuji K, Aoki K, Henzan H, et al. Cidofovir for treating adenoviral hemorrhagic cystitis in hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2004;34:909-914. https://doi.org/10.1038/sj.bmt.1704682
  8. Savona MR, Newton D, Frame D, Levine JE, Mineishi S, Kaul DR. Low dose cidofovir treatment of BK virus-associated hemorrhagic cystitis in recipients of hematopoietic stem cell transplant. Bone Marrow Transplant 2007;39:783-787. https://doi.org/10.1038/sj.bmt.1705678
  9. Ribaud P, Scieux C, Freymuth F, Morinet F, Gluckman E. Successful treatment of adenovirus disease with intravenous cidofovir in an unrelated stem-cell transplant recipient. Clin Infect Dis 1999;28:690-691. https://doi.org/10.1086/517222