Allogeneic stem cell transplant recipients are at risk of BK virus-associated
hemorrhagic cystitis. This condition causes a significant morbidity and worsens clinical outcomes. The standard cares for BK virus-associated
hemorrhagic cystitis are saline irrigation and forced diuresis. Notably, several beneficial roles are proposed for
antiviral and
anti-inflammatory agents against BK virus-associated
hemorrhagic cystitis. However, cases who are at risk of
cystectomy remain refractory. Herein, we present a 13-year-old boy with severe
hematuria by passing two months from his allogeneic
stem cell transplantation. The laboratory work up showed high BK
viremia >1.1 × 108 copies/ml in this case's urine sample. The patient was treated with
antiviral agents in combination with supportive care. Moreover, intravesical
alum was administered, but no clinical benefits were achieved. Finally, intravesical
alprostadil was prepared under the supervision of a pediatric clinical pharmacist. In this regard, an
alprostadil solution was prepared by constitution of 250 μg
alprostadil in 50 mL saline. After administrating the first dose of intravesical
alprostadil, an acceptable clinical response was observed, and
hematuria stopped. Of note,
alprostadil induces platelet aggregation and vasoconstriction. Thus,
bleeding can be controlled after the administration of intravesical
alprostadil. This strategy may be associated with several side effects including bladder
spasm. This study is the first report describing the special role of intravesical
alprostadil in refractory cases of BK virus-associated
hemorrhagic cystitis. In such refractory cases, clinicians can use intravesical
alprostadil rather than invasive
therapies in the treatment of BK virus-
hemorrhagic cystitis.