Haemorrhagic Cystitis in a Case of Secondary Pelviureteric Junction Obstruction: A Rare Case Report

Haemorrhagic cystitis ranges in severity from a transient condition to a life-threatening condition which may quickly resolve or require intervention on a priority basis. It is characterised by bleeding from the bladder mucosa and diffuse inflammation. Case of fungal haemorrhagic cystitis with secondary Pelviureteric Junction Obstruction (PUJO) is relatively rare. Hereby, the authors present a case of 57-year-old male who presented to Emergency Department with painful haematuria and increased frequency of micturition, found to have bladder clots and right secondary PUJO on diagnostic investigation. Clot evacuation and bleeder fulguration with right Double J (DJ) stenting was done. Urine culture and sensitivity report was suggestive of budding yeasts. Uncontrolled diabetes mellitus, with an HbA1c of 8.1%, could explain it. He was discharged on postoperative day two with oral cephalosporins and oral antifungals with Foley catheter in-situ. It was followed by Diethylene Triamine Penta Acetic Acid (DTPA) scan 15 days later, which revealed an enlarged, poorly functioning hydronephrotic obstructed right kidney with Glomerular Filtration Rate (GFR) of 5.7 mL/ min, and satisfactorily functioning hydroureteronephrotic left kidney with GFR of 54.6 mL/min. Right open simple nephrectomy was done through the 11th rib flank incision to prevent future complications. Haemorrhagic cystitis should be kept as a differential diagnosis in patients with haematuria not responding to conservative management with multiple co-morbidities. Management of underlying cause remains the key to treatment.