Cephalexin-Induced Hemorrhagic Cystitis in a Child

Hemorrhagic Cystitis (HC) is an infectious or noninfectious process that leads to gross hematuria originating from the urinary bladder mucosa. A previously healthy 2.5-year-old boy was referred to our center five hours after ingestion of 120 ml (6 g) of cephalexin suspension with abdominal pain, diarrhea, vomiting, and gross hematuria. The results of the general physical examination were unremarkable except for mild suprapubic tenderness. He was admitted to the hospital and hydrated.Laboratory tests on admission showed normal CBC & electrolytes, normal PT&PTT, negative coombs test, many RBCs per high-power field (HPF) in the urine, and normal urinary tract sonography. 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.