止血に困難を極めたCyclophosphamide膀胱炎の1例

A CASE WITH LIFE-THREATENING BLEEDING DUE TO CYCLOPHOSPHAMIDE HEMORRHAGIC CYSTITIS

はじめに

　Cyclophosphamide　（以後CPM）は，悪性腫瘍に広く使用されているアルキル化剤であるが，その特異的な副作用として出血性膀胱炎がある。今回われわれは，止血に困難を極め，尿路変更を余儀なくされた症例を経験したので報告する。

A five-year-old boy with metastatic testicular tumor (embrional carcinoma) had received a total of 4,515mg (270mg/kg) of cyclophosphamide therapy over a period of 18 months. It induced life-threatening hemorrhagic cystitis, and partial cystectomy was done. But after several days, intractable bleeding and clot retention recurred, which developed acute renal failure due to post renal obstruction. After peritoneal dialysis for 19 days, bilateral ureterocutaneostomy was done, and hemostasis was accomplished with the intravesical instillation of formalin. Cyclophosphamide hemorrhagic cystitis was discussed including its pathogenesis.