[PAGID] CGD and bladder wall thickening

[Daniel Conway]

Our experience has been different.  We have sought the source of the infection (urine culture).  This is not uncommon in adult urology with individuals with cystostomy tubes.  Bladder wall infections occur.  The granulomatous piece is the child's particular responses to the infection.  We have tried various antibiotics to gain control of the infections (first a trial of vanco, then cephalosporins).  We've even tried macrolides with success when these more routine antibiotics have failed (targetting what?  ureaplasma? nontuberculous mycobacterium?  Admittedly we're not sure).  We used ultrasound evaluations of bladder wall thickness to determine length of therapy.  Symptoms (dysuria, hematuria, frequency) resolved quickly with antibiotics.  
 
We struggle to avoid long term steroids.
 
Additionally, we have found that with that one patient (at this particular age) was a "retainer" in the words of our urologist at the same age.  He urinated infrequently, all of a sudden with extreme urgency (as is not uncommon for boys of age 4).  He was constipated also.  We worked on increasing frequency of attending to urination, and used antibiotics.  He improved.  It has recurred, usually by November because elementary school results in less frequent ability to attend to toiletting, but he still responds to antibiotics.  
 
As far as the risk of biopsy, the lesions we've seen are very vascular (or neovascular) and the one biopsy we did not only failed to yield an organism but resulted in a lot of bleeding.  
 
Best of luck.  Sincerely, Daniel H. Conway, MD St. Christopher's Hospital for Children Drexel University College of Medicine 
215-427-5284 > Date: Mon, 3 Mar 2008 16:41:43 -0600> From: cmseroogy at pediatrics.wisc.edu> To: pagid at list.clinimmsoc.org> Subject: [PAGID] CGD and bladder wall thickening> > > We have a 4y/o boy with X-linked CGD and a right wall bladder thickening,> dysuria and hematuria. Culture negative, ESR normal and afebrile.> > The imaging consisted of U/S and CT with contrast. It does not have the> characteristics of a rhabdo and given his age in situ carcinoma is rare. I> am inclined to assume this is non-infectious granulomatous disease and treat> with oral steroids. His history is notable for gastric antrum granulomas> this past Fall responsive to oral steroids and aspergillus pneumonia at> presentation 3 years ago.> > My questions:> > > 1. Would people be comfortable with empiric steroid treatment or is the> risk/invasive nature of cytoscopy with bx/culture warranted?> > 2. Should empiric antibiotics be started? If so, what regimen?> > Thank you for your thoughts! Chris> > > > Chris Seroogy, M.D.> > Assistant Professor> > Dept. of Pediatrics> > Mail:  H4/474 CSC, Mailstop 4108> > Shipping:  H4/431 CSC, Mailstop 4108> > 600 Highland Ave.> > Madison, WI  53792> > phone: 608- 263-2652> > fax: 608-265-0164> > 
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