New case of secondary bladder amyloidosis with massive hematuria—role of intravesical instillations with dimethyl sulfoxide

Abstract

Secondary bladder amyloidosis is a rare condition with less than 60 cases published in the world. It is usually secondary to chronic inflammatory processes such as rheumatologic diseases. Hematuria is its predominant and most important symptom, and usually occurs after a bladder catheterization. The diagnostic confirmation is made through a pathological and immunohistochemical study. The treatment must be staggered from less to more invasive. Our objectives are to present a new case of secondary bladder amyloidosis in a woman with a history of chronic bronchiectasis after tuberculosis and frequent super infections, whose main manifestation was a massive hematuria, and review this rare pathology. We have obtained very good initial results using intravesical instillations with dimethyl sulfoxide (DMSO) with complete resolution of the hematuria, the patient remaining asymptomatic for 6 months. After that, there was a recurrence of the hematuria that was treated with embolization of the hypogastric arteries, with good results. We can conclude that, despite being a rare condition, we must consider secondary bladder amyloidosis in patients who have already been diagnosed with systemic amyloidosis and/or chronic pathologies who develop hematuria after bladder catheterization. Based on our experience, instillations with dimethyl sulfoxide are a safe option and provide a quick and temporary resolution of hematuria symptoms.

Is corona virus infection a risk factor for hematuria in secondary bladder amyloidosis? The first case report

“…There have only been a few reports published so far on vesical amyloidosis in patients with RA. However, 5 of 10 patients (50%) with vesical amyloidosis died because of continuous massive hematuria, which induced disseminated intravascular coagulation and multiple organ failure 4 and any additional stress increase the hematuria and mortality rate like our case that was COVID-19 positive and after intubation without any urological intervention her hematuria (that was stopped after cystoscopy and biopsy) recurred.…”

Renal amyloidosis in ankylosing spondylitis - an unusual indication for a renal replacement therapy

“…Zajęcie pęcherza lub prostaty jest jednak bardzo rzadkie, częściej związane z pierwotną postacią choroby, a jej leczenie zwykle rozpoczyna się od mniej radykalnych metod, m.in. przezcewkowej resekcji zmiany (TUR) lub terapii z wykorzystaniem sulfotlenku dwumetylu (DMSO) [14].…”