Many extravasated RBCs fill the lamina propria, which also shows edema and chronic inflammation. There is denudation of much of the overlying transitional epithlium. Image
Hemorrhagic cystitis is uncommon and is most often seen in the setting of chemotherapy, or viral infection. The latter may arise in children as a result of certain subtypes of adenovirus, or BK virus. The mechanism for chemotherapy involves breakdown products of the agent, such as the formation of the substance acrolein from cyclophosphamide, which then accumulates in the bladder, resulting in severe irritation and ulceration.
Hemorrhagic cystitis results in hematuria, dysuria, and irritative bladder symptoms. In immunocompromised patients such as bone marrow transplant recipients, pyuria may be seen.
Viral hemorrhagic cystitis in otherwise healthy children resolves spontaneously in about a week. In those receiving cyclophosphamide, aggressive hydration and administration of a 2-mercaptoethane sulfonate intravenously helps neutralize the toxicity.
Good outcome, although there is the potential for recurrent or chronic urinary tract infections.