Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200032
Brazilian Journal of Pain
Case Report

Actinic cystitis associated with urinary tract infection by Candida glabrata as a differential diagnosis of pudendal neuralgia. Case report

Cistite actínica associada à infecção de trato urinário por Candida glabrata como diagnóstico diferencial de neuralgia do pudendo. Relato de caso

Lidia Yanka Hoffmann; Alexandre Daronco; Eduardo Hildebrand Seyboth

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Abstract

BACKGROUND AND OBJECTIVES: Chronic pelvic pain is still a little-known syndrome with different etiological agents, high morbidity rate, with little information about its etiopathogenesis, which makes its treatment difficult, with symptoms that significantly impact the patient’s quality of life. Among the conditions that lead to chronic pelvic pain, actinic cystitis stands out, a complication of pelvic radiotherapy. This pathology presents signs, symptoms, and complications similar to pudendal neuralgia. The objective of this report is to present one of the etiologies of chronic pelvic pain and its treatment.

CASE REPORT: Sixty-three-year-old male patient who sought medical care with a history of chronic pelvic pain attributed to pudendal neuralgia. The diagnosis was actinic cystitis, resulting from pelvic radiotherapy for prostate adenocarcinoma and urinary tract infection by Candida glabrata, an opportunistic fungal agent. The patient was treated with fluconazole with total control of the painful symptoms and significant improvement in the quality of life.

CONCLUSION: A case report with total pain control in a patient with an initial diagnosis of pudendal neuralgia, who after the clinical evaluation, imaging tests, cystoscopy, and lab tests was diagnosed with actinic cystitis associated to the urinary tract infection by Candida glabrata.

Keywords

Candida glabrata, Cystitis, Pelvic pain, Pudendal neuralgia

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor pélvica crônica é uma síndrome ainda pouco conhecida, com diferentes agentes etiológicos, com alta morbidade, com poucas informações sobre sua etiopatogênese, dificultando seu tratamento, com sintomas que impactam de modo significativo a qualidade de vida do paciente. Entre as inúmeras causas está a cistite actínica, complicação da radioterapia pélvica, que apresenta sinais, sintomas e complicações semelhantes à neuralgia do pudendo. O objetivo deste relato foi apresentar uma das etiologias da dor pélvica crônica e seu tratamento.

RELATO DO CASO: Paciente do sexo masculino, 63 anos, que procurou o serviço médico com história de dor pélvica crônica atribuída à neuralgia do pudendo. Foi feito o diagnóstico de cistite actínica causada por radioterapia pélvica para tratamento de adenocarcinoma de próstata e infecção de trato urinário pelo agente fúngico oportunista Candida glabrata, e instituído tratamento com fluconazol com controle total da sintomatologia dolorosa e melhora acentuada da qualidade de vida.

CONCLUSÃO: Relato de caso com controle total da dor em paciente que apresentava diagnóstico inicial de neuralgia do pudendo, que após avaliação clínica, imaginológica, cistoscópica e laboratorial foi diagnosticado com cistite actínica associada à infecção de trato urinário por Candida glabrata.

Palavras-chave

Candida glabrata, Cistite, Dor pélvica, Neuralgia do pudendo

References

Pereira A, Pérez-Medina T, Rodríguez-Tapia A, Rutherford S, Millan I, Iglesias E. Chronic perineal pain: analyses of prognostic factors in pudendal neuralgia. Clin J Pain. 2014;30(7):577-82.

Hibner M, Desai N, Robertson LJ, Nour M. Pudendal neuralgia. J Minim Invasive Gynecol. 2010;17(2):148-53.

Pérez-López FR, Hita-Contreras F. Management of pudendal neuralgia. Climacteric. 2014;17(6):654-6.

Mangano MS, De Gobbi A, Ciaccia M, Lamon C, Beniamin F, Maccatrozzo L. Actinic cystitis: causes, treatment and experience of a single centre in the last five years. Urologia. 2018;85(1):25-8.

Antolak SJ, Antolak CM. Chronic pelvic pain: neurogenic or non-neurogenic? Warm detection threshold testing supports a diagnosis of pudendal neuropathy. Pain Physician. 2018;21(2):E125-35.

Thompson A, Adamson A, Bahl A, Borwell J, Dodds D, Heath C. Guidelines for the diagnosis, prevention and management of chemical-and radiation-induced cystitis. J Clin Urol. 2014;7(1):25-35.

Pascoe C, Duncan C, Lamb BW, Davis NF, Lynch TH, Murphy DG. Current management of radiation cystitis: a review and practical guide to clinical management. BJU Int. 2019;123(4):585-94.

Sommariva ML, Sandri SD, Guerrer CS. Treatment of acute iatrogenic cystitis secondary to bladder chemo-immuno-instillation or pelvic radiotherapy. Urologia. 2010;77(3):187-92.

Smit SG, Heyns CF. Management of radiation cystitis. Nat Rev Urol. 2010;7(4):206-14.

Browne C, Davis NF, Mac Craith E, Lennon GM, Mulvin DW, Quinlan DM. A narrative review on the pathophysiology and management for radiation cystitis. Adv Urol. 2015;2015:346812.

Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2015;62(4):e1-50.

Charlier C, El Sissy C, Bachelier-Bassi S, Scemla A, Quesne G, Sitterlé E. Acquired flucytosine resistance during combination therapy with caspofungin and flucytosine for Candida glabrata cystitis. Antimicrob Agents Chemother. 2016;60(1):662-5.

Jiménez-Guerra G, Casanovas Moreno-Torres I, Gutiérrez-Soto M, Vazquez-Alonso F, Sorlózano-Puerto A, Navarro-Marí JM. Inpatient candiduria: etiology, susceptibility to antifungal drugs and risk factors. Rev Esp Quimioter. 2018;31(4):323-8.


Submitted date:
07/16/2019

Accepted date:
03/19/2020

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