A paraplegic patient with fever and leucocytosis: not always what it seems

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.