ENCRUSTING CYSTITIS IN CHILDREN: BIBLIOGRAPHICAL REVIEW AND A CLINICAL CASE

Abstract

Encrusting cystitis (EC) is not a rare condition in a pediatric urologist’s practice in which layers of precipitated salts form on the inflamed mucosa. It is believed that urease-producing microorganisms are responsible for the development of this disease, of which the most important is Corynebacterium urealiticum. The pathogenicity factors in this bacterium determine its ability to form biofilms, invade the mucous membrane and alkalinize urine. Intensely turbid urine with an ammonia smell can serve as a hallmark for EC despite dysuric phenomena only, which in its turn is the most often characteristic of all cystitis, is the clinical picture for EC. Thus, in urinalysis the attention should be paid to alkaline pH, crystalluria, hematuria and leukocyturia. The most reliable way to diagnose EC is to visualize crystalline deposits against the background of edematous and hyperemic mucosa during cystoscopy, some changes can also be seen on CT and ultrasound of the urinary system. Treatment of EC cystitis is complicated by multiresistance of the Corynebacterium urealiticum, which determines the need for the selection of therapy based on urine culture with the determination of sensitivity to antibiotics. Scientifically observed EC reports in children are extremely rare. Authors therefore offer a description of their own clinical case: a 9-year-old boy was hospitalized twice at the I.N. Grigovich Children's Republican Hospital of the Republic of Karelia (Petrozavodsk, Republic of Karelia, Russia); the first hospitalization was a month after a suffered SARS-CoV-2 infection with subfebrile condition and dysuric manifestations. Bullous cystitis was diagnosed. With positive dynamics against the background of standard therapy, the patient was discharged. Then, 4 days after the discharge, dysuric phenomena had reappeared with temperature rises, first to subfebrile and then to febrile values. A month after the first discharge, the patient had been readmitted again. EC was revealed, electroexcision of the mucosa with encrustations was performed. The result of the treatment was the recovery.