Case Report Treatment of Severe Refractory Hematuria due to Radiation-Induced Hemorrhagic Cystitis with Dexamethasone José Carlos Rodrigues Nascimento, 1 Márcio Wilker Soares Campelo, 1 Iuri Arruda Aragão, 2 José Fernando Bastos de Moura, 3 Lúcio Flávio Gonzaga Silva, 3,4 and Reinaldo Barreto Oriá 1 1 Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil 2 Unimed Regional Hospital, Fortaleza, CE, Brazil 3 Cancer Institute of Ceara, Fortaleza, CE, Brazil 4 Department of Clinical Medicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil Correspondence should be addressed to Jos´ e Carlos Rodrigues Nascimento; jcr.nascimento@hotmail.com Received 4 April 2017; Accepted 22 May 2017; Published 21 June 2017 Academic Editor: Edgar M. Carvalho Copyright © 2017 Jos´ e Carlos Rodrigues Nascimento et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Treatment of pelvic neoplasms with radiotherapy may develop sequelae, especially RHC. An 85-year-old male patient was admitted to a hospital emergency with gross hematuria leading to urinary retention and was diagnosed with RHC. Te urinary bladder was probed, unobstructed, and maintained in continuous three-way saline irrigation. During 45 days of hospitalization, the patient underwent two cystoscopic procedures for urinary bladder focculation, whole blood transfusions, and one platelet apheresis. None of these interventions led to clinical resolution. As the patient hematological condition was deteriorating, dexamethasone (4mg i.v., bolus of 6/6, 12/12, and 24 h during fve days) and epoetin alpha (1000 IU, 1 ml, s.c., for four weeks) were administered which led to the remission of the urinary bleeding. Dexamethasone therapy may be considered for RHC, when conventional treatments are not efective or are not possible, avoiding more aggressive interventions such as cystectomy. 1. Introduction Pelvic neoplasms, such as in the prostate, bladder, rectum, uterus, ovary, and cervix cancer, may be treated with radio- therapy alone or in combination with chemotherapy. Difer- ent total dose of radiation varies according to cancer severity and higher doses likely increase the odds of toxicity in the genitourinary system. Te urinary bladder is particularly sensitive to low radiation doses and is ofen more afected than other pelvic tissues [1], especially due to low urothelium cell turnover [2]. RHC accounts for 23% to 80% of all complications related to pelvic radiation, with an incidence of severe hematuria ranging from 5% to 8% [3]. RHC may occur 3 months to even 14 years afer radiotherapy and men are more predisposed than women (2.8 : 1), as prostate cancer is ofen treated with radiotherapy sessions [1, 4]. RHC is characterized by progres- sive fbrotic obliteration of mucosal arterioles and capillaries, leading to tissue hypoxia and necrosis [3]. Cystoscopy depicts neovascularization and telangiectasia, which can result in severe and refractory macroscopic hematuria [1]. Gross and prolonged hematuria may require successive blood transfu- sions, several hospital admissions, and surgical treatments to the patient, increasing hospital costs and mortality rates [5, 6]. Te diagnosis of hemorrhagic cystitis is defned by anam- nesis, urine examination, urinary cytology, and cystoscopy. Computed tomography may be important to rule out upper urinary tract injury as a cause of hematuria and magnetic resonance imaging is important in the presence of prior pelvic tumor diagnosis [3]. Various treatment approaches may be indicated for RHC, such as bladder irrigation; intravesical treatment with alum Hindawi Case Reports in Medicine Volume 2017, Article ID 1560363, 3 pages https://doi.org/10.1155/2017/1560363