Cephalexin Induced Cystitis - Pournasiri Z et al Journal of pediatric nephrology | Volume 1 | Number 1| July 2013 37 Case Report J Ped. Nephrology 2013 July;1(1):37-38 http://journals.sbmu.ac.ir/jpn Hemorrhagic Cystitis Following Cephalexin Overdose in a Child How to Cite This Article: Pournasiri Z, Farnaghi F, Mehregan F, Tehranchi ST. Hemorrhagic Cystitis Following Cephalexin Overdose in a Child. J Ped. Nephrology 2013 July;1(1):37-38. Zahra Pournasiri,¹* Fariba Farnaghi,¹ Fereshteh Mehregan,¹ Sedigheh Tehranchi¹ 1 Shahid Beheshti University of medical science, Loghman-Hakim Hospital *Corresponding Author Zahra Poornasir Loghman-Hakim Hospital. Tehran-Iran Email: Pournasiri.z@gmail.com Hemorrhagic Cystitis (HC) is an inflammatory process that leads to gross hematuria originating from the urinary bladder. A previously healthy 2.5-year- old male was referred to hospital five hours after ingestion of 120 ml (6 gr) of cephalexin suspension with abdominal pain, diarrhea, vomiting and gross hematuria. The results of physical examination were unremarkable except for mild suprapubic tenderness. He was admitted and hydrated. Laboratory tests on admission showed normal CBC & electrolytes, PT&PTT and negative coombs test. Many RBCs per high-power field (HPF) in the urine and normal urinary tract sonography were detedted. Within 24 hours, the urine cleared, showing only 1 to 2 red blood cells per high power field with no changes in the CBC, electrolytes, or kidney function tests. His urine culture was negative. Although there are reports of antibiotic- induced HC, the rarity of cephalosporins and cephalexin induced hemorrhagic cystitis encouraged us to report this observation. Keywords: Cystitis; Hematuria; Cephalexin; Poisoning; Child. Received: 2-Nov-2012 Last Revised: 3-Dec-2012 Accepted: 7-Dec-2012 Running Title: Cephalexin-Induced Cystitis Introduction Hemorrhagic cystitis (HC) is an infectious or noninfectious inflammatory process that leads to gross hematuria originating from the urinary bladder mucosa. The etiology of HC might be viral, bacterial, parasitic, or fungal infections; drugs; radiation; chemicals (aniline or toluidine, insecticides); or rarely idiopathic. Two major drug groups as the cause of HC are anticancer drugs, mainly cyclophosphamide, and antimicrobial drugs. Hemorrhagic cystitis occurs in up to 70% of the patients exposed to high doses of cyclophosphamide or iphosphamide and in 15% of patients who undergo pelvic irradiation for the treatment of malignancy [1,2]. Other extremely rare reports include associations with food poisoning (Salmonella typhi), prolonged high-altitude air travel (Boon disease) [3,4] and collagen vascular diseases like SLE [5]. The clinical presentation of hemorrhagic cystitis includes hematuria, dysuria, and frequency. Criteria for the diagnosis of hemorrhagic cystitis include a history of gross hematuria, laboratory findings of gross hematuria (>5 red blood cells/high-power field) platelet count >50,000/mm ³ and a negative urine culture [6]. The bleeding can range from minimal (5 to 50 RBC per high powered field on microscopic examination of the urine), to massive, requiring transfusion to maintain hemoglobin levels [7]. Case Report A previously healthy 2.5-year-old boy was referred to Loghman-Hakim Poison Center five hours after ingestion of 120 ml (6 g) of cephalexin suspension with abdominal pain, diarrhea, vomiting, and gross hematuria. On physical examination, the patient was in no distress. He was afebrile, his blood pressure was 90/50 mm Hg, his respiratory rate was 20/min, and his pulse rate was 100/min. The results of the general physical examination were unremarkable except