Drug-induced hemorrhagic cystitis.

A case of ticarcillin-induced hemorrhagic cystitis is presented, and the literature on drug-induced hemorrhagic cystitis is reviewed. A 12-year-old white boy with cystic fibrosis was hospitalized for an exacerbation of his pulmonary disease. Laboratory tests on admission showed an elevated white blood cell (WBC) count, 10-20 WBCs per high-power field (HPF) in urine, and normal BUN and serum creatinine. The patient was given ticarcillin i.v. (as the disodium salt) (final dosage of 320 mg/kg/day) in divided doses every six hours and netilmicin i.v. (as the sulfate salt) (final dosage of 4 mg/kg every eight hours). On day 7 the patient complained of painful urination, and urinalysis showed a 10-20 WBCs/HPF and 2-5 red blood cells (RBCs)/HPF. Two days later, the patient had gross hematuria, and urinalysis revealed 10-20 WBCs/HPF and 10-20 RBCs/HPF. Ticarcillin and netilmicin were discontinued and the patient's symptoms abated within 48 hours. Repeat urinalysis on day 11 showed no RBCs and 10-20 WBCs/HPF, with no casts or protein. Three months later, the patient was again hospitalized for an exacerbation of his cystic fibrosis. He was placed on tobramycin sulfate i.v. and ticarcillin i.v. (340 mg/kg/day). After the fourth dose of ticarcillin, the patient again complained of urinary pain and frequency and also reported gross hematuria. Urinalysis showed bacteria, 2-5 WBCs/HPF, and 5-10 RBCs/HPF; however, urine cultures were negative. Ticarcillin was discontinued and cefoxitin sodium i.v. was started. The patient's symptoms resolved within 36 hours, and a urinalysis on the fourth hospital day was normal.(ABSTRACT TRUNCATED AT 250 WORDS)