Introduction
Hemorrhagic cystitis (HC) is a common complication following
hematopoietic stem cell transplant (HCT) associated with viral
infections and/or administration of high dose cyclophosphamide
(CY).1,2 Preventative measures including
hyperhydration and the acrolein-neutralizing agent mesna are useful in
preventing HC but do not prevent all cases.3 Once HC
occurs, the associated dysuria can be debilitating and difficult to
treat.1 For this reason, multiple agents are used to
treat severe dysuria. This poly-pharmacy approach may lead to drug
related adverse effects and complicate the post-HCT recovery phase. We
present a case of a girl who experienced HC secondary to CY, treated
conservatively with hyperhydration, phenazopyridine, and oxybutynin, who
suddenly developed acute hemolysis.