A 56-year-old Japanese man with biopsy-proven NSCLC was receiving active therapy with irinotecan (60 mg/m2) and cisplatin (60 mg/m2). Previously, the patient had had no significant genitourinary history. The combination of irinotecan and cisplatin was stopped because of persistent neuropenic fever and severe fatigue, and oral gefitinib (250 mg once a day) was initiated. Approximately two weeks later, severe LUTS, fever > 101.5°F and cough were noted. Urinalysis demonstrated fewer than 5 red blood cells/high power field, no white blood cells and no bacteria. Urine culture was negative. Sputum cultures showed chlamydial pneumonia, and the patient was started on moxifloxacin, with immediate improvement of cough but minimal improvement of fever, LUTS and hematuria. Over the next month, these symptoms persisted, together with deterioration of hepatic and renal function. Gefitinib therapy was halted. Empirically, ceftazidime was initiated and fever improved. Two weeks after stopping gefitinib, hepatic and renal function returned to normal. However, LUTS and microscopic hematuria continued despite negative urine cultures. The patient was referred to the Urology Department, and thorough investigation of hematuria (i.e., intravenous pyelography (IVP) assessing the kidneys and ureters and cystourethroscopy) was performed. IVP was normal except for a contracted, thickened bladder wall (Figure. ). Cystourethroscopy revealed a small capacity bladder with erythematous lesions throughout the bladder. Because of the small capacity bladder, hydrodilation was performed. No discrete tumors or bladder calculi were noted. The prostatic urethra was unremarkable without trilobar hypertrophy or a prominent median lobe. Random bladder biopsies were obtained as well as urinary cytological examination. Urinary cytology was negative for malignancy. Histological examination of the bladder biopsies showed areas of denuded mucosa, submucosal edema, increased vascularity and white blood cell infiltration, indicative of hemorrhagic cystitis (Figure. ). The symptoms improved over the ensuing four weeks.
Intravenous pyelography showed contracted bladder.
Microscopic findings of bladder biopsy specimens revealed histological changes associated with hemorrhagic cystitis (× 10).