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A paraplegic patient with fever and leucocytosis: not always what it seems
Affiliations- Department of Internal Medicine, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
- Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
- Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Department of Urology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
- Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Abstract
A 54-year-old obese woman with a history of spina bifida was admitted to the hospital with malaise and fever accompanied by leucocytosis, thrombocytosis, and hypercalcaemia. As treatment for neurogenic bladder dysfunction she had a suprapubic catheter. Diagnostic workup for osteomyelitis revealed an unknown mass originating from the urinary bladder on MRI of the pelvis. Further diagnostic analyses showed that the mass was a squamous-cell carcinoma (SCC) with laboratory abnormalities as paraneoplastic phenomena mediated by PTH-related peptide and cytokines released by the SCC. Despite radiotherapy the patient died within two months after initial diagnosis. Squamous-cell carcinoma of the bladder is rare in western countries. In unresectable or metastatic disease survival rates are low due to low responsiveness to standard chemotherapy. Concurrent chemoradiotherapy might be an alternative in unresectable or locally advanced disease; however, evidence to support this is lacking. The poor survival in these patients raises the question of whether high-risk groups for SCC of the bladder, like paraplegic patients or patient with neurogenic bladder dysfunction, should receive screening even though the ideal starting point and frequency are still unknown.
Abstract
A 54-year-old obese woman with a history of spina bifida was admitted to the hospital with malaise and fever accompanied by leucocytosis, thrombocytosis, and hypercalcaemia. As treatment for neurogenic bladder dysfunction she had a suprapubic catheter. Diagnostic workup for osteomyelitis revealed an unknown mass originating from the urinary bladder on MRI of the pelvis. Further diagnostic analyses showed that the mass was a squamous-cell carcinoma (SCC) with laboratory abnormalities as paraneoplastic phenomena mediated by PTH-related peptide and cytokines released by the SCC. Despite radiotherapy the patient died within two months after initial diagnosis. Squamous-cell carcinoma of the bladder is rare in western countries. In unresectable or metastatic disease survival rates are low due to low responsiveness to standard chemotherapy. Concurrent chemoradiotherapy might be an alternative in unresectable or locally advanced disease; however, evidence to support this is lacking. The poor survival in these patients raises the question of whether high-risk groups for SCC of the bladder, like paraplegic patients or patient with neurogenic bladder dysfunction, should receive screening even though the ideal starting point and frequency are still unknown.
Keywords
suprapubic catheter, squamous-cell carcinoma suprapubic tract, neoplastic phenomena
About this articleTitle
A paraplegic patient with fever and leucocytosis: not always what it seems
Journal
Issue
Article type
Case report
Published online
2019-04-16
Page views
445
Article views/downloads
447
DOI
10.5603/OCP.2019.0005
Bibliographic record
Oncol Clin Pract 2019;15(1).
Keywords
suprapubic catheter
squamous-cell carcinoma suprapubic tract
neoplastic phenomena
Authors
Ashley J.R. De Bie
Simon Körver
Erik Kersten
Jérôme M.H. Kisters
Henricus J.E.J. Vrijhof
Jeroen Willems
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