Hemorrhagic Cystitis with Giant Cells in Rheumatoid Arthritis Treating with Tacrolimus

In Suk Min; YeonMi Ju; Hyun-young Kim; Yun Jung Choi; Won-Seok Lee; Wan-Hee Yoo

doi:10.4078/jrd.2014.21.6.336

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Min, Ju, Kim, Choi, Lee, and Yoo: Hemorrhagic Cystitis with Giant Cells in Rheumatoid Arthritis Treating with Tacrolimus

Case Report

J Rheum Dis 2014;21(6):336-339.

Published online: 31 October 2014

DOI: https://doi.org/10.4078/jrd.2014.21.6.336

Hemorrhagic Cystitis with Giant Cells in Rheumatoid Arthritis Treating with Tacrolimus

In Suk Min, YeonMi Ju, Hyun-young Kim, Yun Jung Choi, Won-Seok Lee, Wan-Hee Yoo

Department of Rheumatology, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University Hospital-Chonbuk National University, Jeonju, Korea

Corresponding to: Wan-Hee Yoo, Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University Hospital-Chonbuk National University, San 2-20, Geumam-dong, Deokjin-gu, Jeonju 561-180, Korea. E-mail: ywhim@jbnu.ac.kr

Received 9 January 2014 Revised 9 April 2014 Accepted 10 April 2014

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hemorrhagic cystitis is a diffuse inflammation of the mucosa of the bladder, characterized by hematuria and burning upon urination. This might be caused by a variety of reasons, including undergoing chemotherapy (such as cyclophosphamide), radiation therapy, bladder cancer, certain viruses, urinary infections, and thrombocytopenia. There are no previous reports of hemorrhagic cystitis associated with the use of tacrolimus. This is the first case of hemorrhagic cystitis due to tacrolimus for the treatment of rheumatoid arthritis. We describe a case of hemorrhagic cystitis with giant cells in a patient with rheumatoid arthritis treating with tacrolimus. Hematuria resolved spontaneously with discontinuation of the drug.

Keywords: Hemorrhagic cystitis, Rheumatoid arthritis, Tacrolimus

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Figure 1.

Ground glass appearance of both lower lung fields on high-resolution CT of the lung (A). Cystoscopic examination of bladder showed erythematous mucosa (B) and atypical giant stromal cells in the lamina propria (arrows) showing enlarged, hyperchromatic, multilobulated nuclei were present on histological examination of cystoscopically biopsied bladder mucosal wall (C, H&E, ×200).

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