Cytomegalovirus-related hemorrhagic cystitis in an immunocompetent child

Abstract

Cytomegalovirus (CMV) infections are mostly seen in immunocompromised patients. However, unusual manifestations or complications of acquired CMV infections in immunocompetent patients are rarely reported. CMV-related hemorrhagic cystitis is extremely rare but should be considered even in immunocompetent patients. We present a case of a 3-year-old immunocompetent boy with intermittent, terminal gross hematuria lasting for 1 month. There was no history of genitourinary trauma or stone disease. Urine analysis revealed hematuria with eumorphic red blood cells and no proteinuria. Urine culture was negative. Ultrasonography showed increased bladder wall thickness and irregularity at inferior of bladder. Cystoscopy revealed hyperemia and edema. Histopathological examination was consistent with CMV infection, viral DNA by polymerase chain reaction in peripheral blood and urine were positive. Clinical, laboratory, and imaging features pointed towards hemorrhagic cystitis due to CMV. He was followed-up with no treatment. After 1 month, repeated investigations showed complete resolution of finding. This is a rare description of an immunocompetent child with CMV-induced cystitis.

Cytomegalovirus infection in non-immunocompromised critically ill patients: A management perspective

“…However, development of thrombosis at unusual sites like internal jugular vein, portal vein, splanchnic vein, and mesenteric veins suggests an underlying procoagulant effect of CMV[ 46 ]. Other rarer manifestations of CMV are cystitis, nephritis and retinitis[ 47 , 48 ].…”

Risk factors for hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation in a letermovir‐exposed CMV‐free population receiving PTCy

“…1 In patients receiving an HSCT, CMV disease shows high mortality-up to 70% 2 -and tends to present more frequently with CMV pneumonitis, followed by gastrointestinal CMV disease, despite some cases of hemorrhagic cystitis (HC) due to CMV has also been reported in immunocompromised patients. [3][4][5] Overall, an incidence of HC between 12.2% and 36.9% is generally reported in the setting of HSCT. Most commonly, HC occurs within the first month after HSCT.…”

“…Patients receiving GVHD prophylaxis with post‐transplant cyclophosphamide (PTCy) show an incidence of CMV infection of 35%–76% of cases, with a full CMV‐disease in up to 17% of cases 1 . In patients receiving an HSCT, CMV disease shows high mortality—up to 70% 2 —and tends to present more frequently with CMV pneumonitis, followed by gastrointestinal CMV disease, despite some cases of hemorrhagic cystitis (HC) due to CMV has also been reported in immunocompromised patients 3–5 …”