2021 Volume 70 Issue 1 Pages 150-154
Here, we report the cases of two patients diagnosed as having ADV-induced hemorrhagic cystitis. They were initially suspected of having this condition on the basis of the characteristic morphology of cells in the urinary sediment and then diagnosed with a rapid immunochromatographic ADV kit for the pharynx. The cells of the patients showed nuclear enlargement, a high N/C ratio, and homogeneously stained dark nuclei (smudgy chromatin) with blurry contours, which were in agreement with previous reports on ADV-infected urinary cells. These morphological characteristics of the ADV-infected cells led us to perform urinary quantitative ADV-PCR analysis using the rapid diagnostic kit for the pharynx, although the kit was not approved for use in urine samples. Later, the ADV-PCR analysis revealed high titers of ADV in both patients. The symptoms of the ADV-induced hemorrhagic cystitis are severe hematuria, frequent urination, and bladder irritation. Because urinary retention caused by a massive blood clot and systemic dissemination of the virus could lead to fatality in severe cases, prompt diagnosis is important. We were able to analyze the cells by the urinary sediment examination before the onset of macroscopic hematuria, leading to early diagnosis and therapy. It is difficult to diagnose ADV infection only on the basis of cell shape determined in the urinary sediment examination. The rapid immunochromatographic kit may be useful for the early diagnosis when suspicious ADV-infected cells are found.
