Cisplatin
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Haemorrhagic cystitis: case report A 15-year-old boy developed haemorrhagic cystitis (HC) during treatment with cisplatin for classic medulloblastoma. The boy, who had severe headache and vomiting presented to the emergency department. On examination, he was diagnosed with classic medulloblastoma. He underwent right frontal external ventricular drain insertion, resection, posterior fossa craniotomy and haematoma evacuation. Thereafter, he received proton beam therapy to craniospinal axis with a boost to the posterior fossa. Further examination revealed no recurrent or residual disease. Subsequently, he was started on postoperative chemotherapy with lomustine, vincristine, cisplatin and cyclophosphamide in cyclic manner. In cycle-1, he received cisplatin 70 mg/m2 [route not stated] along with vincristine and lomustine on day-1. On day-2, he developed severe haematuria with gross clots that led to significant dysuria. Based on this observation, he was suspicious for HC. An ultrasound demonstrated a normal urinary bladder with a wall thickness at the upper limit of normal. Urology review was significant with the diagnosis of HC [duration of treatment to reaction onset not stated]. The boy declined catheterisation and was managed conservatively with unspecified IV fluids at 150% for maintenance and analgesia. Laboratory investigations revealed elevated creatinine levels. He had a prolonged prothrombin time and was started on vitamin K 5mg twice daily. Subsequently, he developed hesitancy, urgency and dysuria due to passage of more clots. He was urinating every 15 minutes at its worst, associated with significant pain. He required red cell transfusion and was treated with oxybutynin, pentosan polysulfate [sodium pentosan polysulphate] and morphine patient-controlled analgesia after review from urology consultant. On day-9, a repeat ultrasound revealed a thickened hyperemic bladder wall with echogenic debris consistent with HC. Infectious aetiology was found to be negative. Laboratory investigations revealed CRP levels at its peak and normal neutrophil count. His condition improved by day-14 and there was no haematuria. Treatment with oxybutynin, patient-controlled analgesia and SPP was discontinued. After resolution of condition, he was started on only vincristine, which he tolerated without adverse events. Then the man was started on same chemotherapy regimen again (vincristine, cisplatin and lomustine) along with unspecified IV fluids at 200% hydration. Urine output was managed with mannitol and he was encouraged to empty his bladder frequently. On this regimen there was no recurrence of HC. Slack D, et al. An Unusual Cause of Hemorrhagic Cystitis in a Teenager With Medulloblastoma. Journal of Pediatric Hematology/Oncology : 11 Sep 2020. Available from: 803506602 URL: http://doi.org/10.1097/MPH.0000000000001949
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Reactions 17 Oct 2020 No. 1826
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