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Case Reports
. 2019 Jan 21;12(1):69-75.
doi: 10.1159/000496331. eCollection 2019 Jan-Apr.

Severe Hemorrhagic Cystitis Caused by Cyclophosphamide and Capecitabine Therapy in Breast Cancer Patients: Two Case Reports and Literature Review

Toshihiro Tanaka  1 , Yuta Nakashima  1 , Hidenori Sasaki  1 , Michio Masaki  1 , Ai Mogi  1 , Kazuo Tamura  1 , Yasushi Takamatsu  1
Affiliations
Case Reports

Severe Hemorrhagic Cystitis Caused by Cyclophosphamide and Capecitabine Therapy in Breast Cancer Patients: Two Case Reports and Literature Review

Toshihiro Tanaka et al. Case Rep Oncol. .

Abstract

Combined oral cyclophosphamide and capecitabine (XC) chemotherapy is used for metastatic breast cancer (MBC) patients. We report herein two MBC patients who developed severe hemorrhagic cystitis after XC therapy. Case 1: A 67-year-old woman with MBC had received XC therapy for 2.5 years. After a sudden onset of lower abdominal pain and gross hematuria, cystoscopy revealed a urinary bladder mucosa showing diffuse dilation of the capillaries and a large blood clot. A total dose of 60.8 g cyclophosphamide had been given and the XC regimen was discontinued immediately. The patient experienced frequent episodes of bladder tamponade over 18 months and underwent continuous bladder irrigation and cystoscopic fulguration. Hyperbaric oxygen therapy (HBOT) provided only temporary relief and the patient subsequently developed hemorrhagic shock. A bilateral ureterostomy was eventually performed. Case 2: A 65-year-old woman with MBC was given XC for 3 years, but this was discontinued after she developed new lung lesions. The patient was given a total dose of 78.4 g of cyclophosphamide. A month later, the patient complained of intermittent gross hematuria, which progressed to persistent macroscopic hematuria for 1 week. She underwent continuous bladder irrigation with saline, without an improvement in her bladder tamponade. Subsequently, the bleeding ceased completely after HBOT. Some MBC cases can be controlled for a long time with XC therapy. For those cases, we need to realize that severe hemorrhagic cystitis may occur. Even at a low dose, requires testing periodically for occult blood in the urine to detect the early stages of cystitis.

Keywords: Breast cancer; Case report; Cyclophosphamide; Hemorrhagic cystitis; XC.

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Figures

Fig. 1
Fig. 1
Cystoscopic examination in case 1 showed erythematous and diffuse dilation of capillaries in the urinary bladder mucosa.
Fig. 2
Fig. 2
A computed tomography (CT) scan in case 2 demonstrating marked bladder wall thickening.
Fig. 3
Fig. 3
Relationship between the thickness of the bladder wall and microscopic hematuria in case 2.
See this image and copyright information in PMC

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