Nonsteroidal anti-inflammatory drugs in the treatment of eosinophilic cystitis

An unusual cause of terminal hematuria in a child: Eosinophilic cystitis

Eosinophilic cystitis is a rare inflammatory disease of the bladder; it rarely occurs in children. Patients typically show irritative urination symptoms frequently, with a possible need for urgency, alongside dysuria, gross haematuria, suprapubic pain and painful urination. Sometimes bladder mass accumulation with the possibility of malignancy is also observed. We present an 8-year-old male patient who gained admission for terminal hematuria and discuss the management of eosinophilic cystitis.

Eosinophilic cystitis with eosinophilic cholecystitis: a rare association

We describe a rare case of eosinophilic cystitis associated with eosinophilic cholecystitis in a 30-year-old patient who underwent bladder biopsy for irritative voiding symptoms and routine elective cholecystectomy for gallstones. Diagnosis was confirmed by histopathological examination. The rarity of this condition prompted us to report this entity in which no specific cause could be found.

[Eosinophilic cystitis: review and two case reports]

Eosinophilic cystitis is a low frequency disease, with less than 200 reported cases in the world. It is characterized by a bladder wall inflammation, mainly by eosinophils, with fibrosis and muscle necrosis areas. Its origin seems to be immunological, although the triggers are not well known. Several predispose factor have been described such as allergic diseases, bladder injuries, drugs, infections, etc. It affects patient of all ages, mainly adults. It presents with frecuency, haematuria and suprapubic pain. Other less frequent symptoms are disuria, urinary retention, nicturia, and enuresis. The laboratory study (urinalysis, urinalysis and haemogram) and radiology (ultrasound, intravenous pyelography, computed tomography and nuclear magnetic resonance) are non specific. The lesions observed in the cystoscopy could emulate other diseases, that why the proper diagnostic is the histological analysis. The management could be observation o antihistaminic, anti-inflammatory and corticoid treatment. In refractory cases, surgery is an alternative. In this work, two male adult cases are reported with their symptoms, studies and management.

Blood eosinophilia, corticoadrenal insufficiency and eosinophilic cystitis

Blood eosinophilia generally indicates an underlying allergic, infectious or hematologic disease. Corticoadrenal insufficiency is known to be another cause of blood eosinophilia. Eosinophilic cystitis is a rare disease in which the bladder wall is infiltrated by eosinophils; however, the etiology of eosinophilic cystitis remains unclear. We report a case of corticoadrenal insufficiency with blood eosinophilia developing gross hematuria and eosinophilic cystitis. The patient was treated with medical therapy, including oral corticosteroids, obtaining excellent results.

Eosinophilic cystitis simulating invasive bladder cancer: a real diagnostic challenge

OBJECTIVES

To report our experience with eosinophilic cystitis (EC) presented as invasive bladder cancer.

MATERIALS AND METHODS

We recently treated three patients with bladder masses mimicking neoplasms and biopsy proved the diagnosis of EC. Data from our three patients were presented.

RESULTS

There were two females and one male with ages of 14, 43 and 38 years. All the three patients had irritative bladder symptoms, suprapubic pain and hematuria. Bladder mass was detected by pelvic examination in the three patients and confirmed by radiologic tests and cystoscopy. In one patient, the mass caused bilateral hydroureteronephrosis while the upper tract was normal in the other two. Elevated serum leukocytes was evident in the three cases while peripheral eosinophilia was observed in one. Biopsy showed EC in all the three patients who were treated by transurethral resection of the lesions followed by a combination of corticosteroids, antibiotics and antihistaminics. All patients experienced marked improvement during a follow-up duration up to 30 months.

CONCLUSION

EC is a rare disease. In addition to symptoms of frequency, dysuria, hematuria and suprapubic pain, the disease may present with a bladder mass mimicking invasive bladder cancer. Resection of the lesion is mandatory with systemic treatment of corticosteroids, antihistaminics and antibiotics. Early detection and prompt treatment usually result in a good prognosis.

Eosinophilic cystitis and its management

Eosinophilic cystitis (EC) is a rare clinicopathological condition characterized by transmural inflammation of the bladder predominantly with eosinophils, associated with fibrosis with or without muscle necrosis. The cause of EC remains unclear, although it has been associated with various aetiological factors, such as allergy, bladder tumour, bladder trauma, parasitic infections and chemotherapeutic agents. EC is, probably, caused by the antigen-antibody reaction. This leads to the production of various immunoglobulins, which, in turn, cause the activation of eosinophils and initiates the inflammatory process. The most common symptom complex consists of frequency, haematuria, dysuria and suprapubic pain. Cystoscopy and biopsy are the gold standard for diagnosis. Additional laboratory evidence supporting the diagnosis includes proteinuria, microscopic haematuria and peripheral eosinophilia, the last one occurring in few patients. There is no curative treatment for this condition. Current treatment modalities include transurethral resection of the bladder lesion along with non-specific medical therapy, such as non-steroidal anti-inflammatory agents or steroids. Because the lesion tends to recur in spite of the above therapy, long-term follow-up is mandatory.

[Bladder fibrosis caused by eosinophilic cystitis]

A 70-years-old man with no history of allergy or genitourinary problems had bilateral hydronephrosis, a marked decrease in bladder capacity and severe eosinophilic infiltration with fibrosis of the bladder wall. A total cystoprostatectomy with ileal bladder replacement was performed. We reviewed the literature of eosinophilic cystitis for clinical presentation, diagnosis and therapeutic options.

Endoscopic treatment of eosinophilic cystitis

Since 1990 we have treated 11 cases of eosinophilic cystitis. All patients were adult or elderly men with an average age of 66.4 years (range 46–83). Seven patients had previous superficial bladder cancer and 5 of these were treated with instillations of mitomycin C. Three patients were hospitalized following repeated episodes of macrohematuria. One case had peritonitis due to spontaneous rupture of the bladder. Cystoscopy showed hyperemic areas in all patients, mamillated areas in 7 cases and ulcerated and necrotic areas in 2 cases. The bladder mucosa appeared bloody in one patient. In nine cases multiple biopsies and wide fulguration of involved areas were performed. Two patients were submitted to complete resection of the lesions. The pathological examination documented an infiltration of eosinophils into the mucosa and lamina propria in all cases; in one of these the infiltration involved the muscularis. The patients have been followed for 24.5 months (range 13–37), with periodic cystoscopy and bladder biopsies. We have not documented recurrences of eosinophilic cystitis. Although the treatment of eosinophilic cystitis is controversial, our experience with diathermic fulguration or transurethral resection has proved effective with minimal invasiveness.

Intravesical thiotepa-induced eosinophilic cystitis

Eosinophilic cystitis is a rare form of an allergic cystitis. Factors such as food allergens, parasites, and drugs have been implicated in the genesis of eosinophilic cystitis. Associated risk factors include bronchial asthma, atopic diseases, and environmental allergens. Intravesical mitomycin is a reported causative agent. We report the first case of eosinophilic cystitis that developed after intravesical instillation of thiotepa for treatment of superficial bladder cancer.

Eosinophilic granulomatous cystitis in children

We report 3 cases of eosinophilic granulomatous cystitis in children. All presented with hematuria, urinary urgency, and dysuria. Treatment with oral corticosteroids led to rapid and complete recovery in 2 of the 3 cases. In the third case recovery was prolonged without the use of steroids. Because of the presumed immunologic nature of this disease, previous authors have recommended the use of corticosteroids in its management. A review of the literature suggests that the disease is probably of immunologic nature and that corticosteroids shorten symptomatic recovery from this disease.

Eosinophilic cystitis: CT findings

Eosinophilic cystitis (EC) is a rare form of bladder inflammation of uncertain etiology, characterized by eosinophilic inflammation of the bladder. Presenting clinical symptoms include hematuria, dysuria, frequency, and suprapubic pain. To our knowledge, there have been only two other reports of computed tomographic (CT) scan findings of EC. In both cases, the findings were thought to represent invasive bladder cancer. We present a case report of biopsy-proven EC with previously unreported CT scan findings.