Eosinophilic cystitis: the relationship of allergy in the urinary tract to eosinophilic cystitis and the pathophysiology of eosinophilia

Eosinophilic cystitis mimicking bladder tumor: A case report

Eosinophilic cystitis (EC) is a rare inflammatory condition characterized by eosinophilic infiltration into the bladder wall. It often presents symptoms common to urological issues such as urinary tract infections, hematuria, bladder stones, or bladder neoplasms. Here, we describe a case of a 44-year-old male veteran with a history of multiple tuberculosis episodes who presented to the Emergency Department with dysuria, suprapubic pain, and gross hematuria. Initial imaging and cystoscopy concerned bladder neoplasia; however, subsequent pathological evaluation showed EC. This case underscores the importance of considering EC in the differential diagnosis of bladder tumors, especially when imaging describes bladder wall thickening in a patient without risk factors for bladder malignancy.

Clinicopathological characteristics and outcomes of eosinophilic cystitis: A retrospective study

Background

Eosinophilic cystitis (EC) is a rare inflammatory urinary bladder disorder whose etiology, pathogenesis, and treatment are unknown. The work aims to evaluate the clinical manifestations, cystoscopic characteristics, pathological features, treatment, and clinical outcome of EC patients.

Materials and methods

The clinical records and histopathology material of 22 patients diagnosed as EC during ten years were reviewed and analyzed for patient's age, sex, clinical data, cystoscopic features, biopsy procedures, treatment plan, follow-up, and prognosis. Frequencies, normality tests, descriptive statistics, and correlations were run.

Results

The mean age of patients was 46.5 + 17 years, 12 females and 10 males. Regarding the patient's complaints, dysuria was the most frequent main symptom, followed by hematuria. On cystoscopic examination, bladder mass was seen in 54.5% of patients. Six patients (27.3%) were associated with different allergic diseases; however peripheral eosinophilia was shown in two patients (9.1%). All cases revealed predominance of eosinophilic infiltration on microscopic examination. The most commonly used medications were corticosteroids for 72.7% of patients with tapering dose giving a significant improvement with a recorded recurrence in one patient after 12 months from the first lesion.

Conclusions

No specific clinical presentation for EC patients and histopathology is the standard diagnostic tool. Medical treatment including corticosteroids was the first line with good prognosis, although recurrence remains a possibility which emphasizes the importance of patients’ follow-up.

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Eosinophilic cystitis is a rare inflammatory disorder of the bladder.

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Etiology, pathogenesis, and treatment are unknown.

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A total of 22 patients were retrospectively studied and analyzed.

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Histopathological examination is standard tool for diagnosis.

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Oral steroids gave a significant improvement.

Eosinophilic cystitis mimicking tuberculosis: An analysis of five cases with review of literature

Eosinophilic cystitis (EC) is a rare disease. It is a transmural inflammation of the bladder, predominantly with eosinophils. High index of suspicion is needed for timely intervention. EC should be kept as a differential diagnosis in patients presenting with lower urinary tract symptoms due to small capacity bladder with a negative workup for urinary tuberculosis and in patients having hematuria and negative cytology, or incidentally found bladder lesions with known risk factors. Initial treatment is conservative with removal of risk factor, anti-histaminics and steroids. Augmentation cystoplasty should be considered in patients with a small capacity bladder. These patients need a strict and long term follow-up.

Presenting manifestations of eosinophilic cystitis in two Filipino children

Eosinophilic cystitis is a very rare clinical disease entity in the pediatric population. We report two cases of Filipino children with eosinophilic cystitis who presented with irritative voiding symptoms, gross hematuria, peripheral eosinophilia, and hydroureteronephrosis and urinary bladder wall thickening visualized on ultrasonography and CT urography. Cystoscopy and transurethral biopsy confirmed the diagnosis. Both patients were started with corticosteroid with or without an antihistamine. Resolution from the signs and symptoms were observed in both patients as documented by disappearance of peripheral eosinophilia, normal urinalysis results, and resolution of the hydroureteronephrosis and urinary bladder wall thickening on ultrasonography on follow-up.

[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.

The Spectrum of Eosinophilic Cystitis in Males: Case Series and Literature Review

Context.—Eosinophilic cystitis (EC) is an inflammatory condition of the bladder that has been linked to food allergens, infectious agents, drugs, and other genitourinary conditions. Like interstitial cystitis, EC has a strong female predominance. It is characterized by an intense eosinophilic infiltrate in the acute phase and fibrosis in the chronic phase.

Objectives.—To document and focus on specific features of EC in males and highlight the relationship between clinical and histopathologic findings.

Design.—The bladder biopsies of male patients were reviewed. Eight cases of EC were selected.

Results.—Several known associations were noted as well as unreported features and associations such as Charcot-Leyden crystals, celiac disease, lupus anticoagulant, and additional viral and bacterial agents.

Conclusions.—Eosinophilic cystitis represents a response to a variety of agents and may often be overlooked. The temporally biphasic morphologic features are the hallmark of this condition. Because clinical and imaging studies are not specific, a high index of clinical suspicion is often crucial to the correct diagnosis and proper management of EC.

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.

Eosinophilic cystitis in a 4-year-old boy: successful long-term treatment with cyclosporin A

A 4-year-old Jewish boy presented with dysuria, urinary dribbling, increased urinary frequency, and new onset of diurnal enuresis. An infiltrating solid mass involving the entire bladder wall was found. Biopsy revealed "tumor-forming" eosinophilic cystitis, a rare bladder lesion of unclear cause. Antitoxocariasis treatment was unsuccessful. High-dose corticosteroids failed. The child's clinical condition and bladder sonographic findings continued to deteriorate. Treatment with cyclosporin A was given for 8 months, with a complete clinical, radiologic, and histopathologic cure and no side effects. Two years of follow-up showed a complete recovery.

Eosinophilic cystitis induced by mitomycin-C

Eosinophilic cystitis is an unusual form of cystitis which is characterized by irritative voiding symptoms and haematuria. In the report herein two adult cases of eosinophilic cystitis treated with intravesical Mitomycin-C instillations for prophylaxis of bladder carcinoma are presented and the literature is reviewed.

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.

Interleukin 5 synthesis by eosinophils: association with granules and immunoglobulin-dependent secretion

Interleukin 5 (IL-5) is the main factor that promotes the terminal differentiation of eosinophil progenitors (as indicated by colony formation assays), and enhances the effector capacity of mature eosinophils. IL-5 is produced by T lymphocytes, CD4-/CD8- and mast cells and recently, messenger (m)RNA of this cytokine has been identified in eosinophils from patients with coeliac disease, asthma, or eosinophilic heart diseases. In this study, IL-5 mRNA and immunoreactive IL-5 protein were detected in tissue and blood eosinophils from patients with eosinophilic cystitis or hypereosinophilic syndromes but not in Crohn's disease. By electron microscopy associated to immunogold staining, immunoreactive IL-5 was identified in eosinophilic granules. After stimulation with IgA-, IgE-, or IgG-immune complexes, blood eosinophils were shown, by immunocytochemistry and by enzyme-linked immunosorbent assay, to secrete IL-5. These observations demonstrate that eosinophils, under physiological stimulation, can release significant amounts of IL-5, which may contribute to local eosinophil recruitment and activation.

Eosinophilic cystitis simulating invasive bladder carcinoma

A case of eosinophilic cystitis simulating an invasive bladder carcinoma is reported. The disease had a subacute course and was associated with arthritis of the symphysis pubis and both sacroiliacal joints.

Eosinophilic cystitis in children

A case of eosinophilic cystitis in a child is presented and the pediatric literature reviewed. The etiology of this condition is still unknown. Mean age of children with eosinophilic cystitis is 5.9 years. Black children appear to be more affected than white children, with a male preponderance. Hematuria and dysuria are the most common symptoms. The diagnosis of eosinophilic cystitis is made by cystoscopy with biopsy. The disease appears self-limited with its course unaltered by antibiotics. Recurrence of eosinophilic cystitis is possible.

Vesical manifestations of chronic granulomatous disease in children. Its relation to eosinophilic cystitis

Two children with chronic granulomatous disease involving the bladder are reported. Their clinical course was characterized by lower urinary tract symptoms, decreased vesical capacity, unilateral ureterovesical junction obstruction, and an intense eosinophilic infiltrate on biopsy specimens in each. Chronic granulomatous disease and eosinophilic cystitis appear to have remarkably similar clinical manifestations. A review of urinary tract involvement in chronic granulomatous disease and its comparison with eosinophilic cystitis is presented.

Eosinophilic gastroenteritis

A review was undertaken of 220 case reports of eosinophilic gastroenteritis involving the gastrointestinal tract, with particular regard to its clinical presentation and management. The stomach was the single commonest site of involvement (43%), while 36% were found to have two or more sites of disease at the time of presentation. The most common presenting symptoms were episodic abdominal pain (77%) and diarrhoea (42%). A history of allergy was present in 52% of patients, while 8% reported aggravation of symptoms following the ingestion of certain foods. Two thirds of patients had reported symptoms of more than six months duration prior to diagnosis, while in 26%, five years or more had elapsed. Although surgical intervention was undertaken in 44% of patients at some stage in their management, the most successful mode of management was the institution of steroid therapy, where 90% reported rapid clinical improvement. There is no evidence that patients with eosinophilic gastroenteritis have a higher incidence of subsequent gastrointestinal malignancies.

Nonsteroidal anti-inflammatory drugs in the treatment of eosinophilic cystitis

A 30-year-old white woman with urinary frequency, left costovertebral angle pain and hematuria had left hydronephrosis, a marked decrease in bladder capacity and severe eosinophilic cystitis on biopsy. She was treated with a nonsteroidal anti-inflammatory drug and an antihistamine, with a dramatic, complete and rapid recovery. The nonsteroidal anti-inflammatory drug was believed to have been responsible for the favorable outcome, since antihistamines have not produced reliable benefits in this disease. Nonsteroidal anti-inflammatory drugs are recommended in cases of eosinophilic cystitis.

Eosinophilic cystitis presenting as invasive bladder cancer: comments on pathogenesis and management

Eosinophilic cystitis is a rare bladder lesion that usually presents with hematuria and has the cystoscopic appearance of a bladder tumor. Ten cases (only 4 adults) have been reported in which this disease has presented with a palpable mass. We report a case in which the lesion presented as an invasive bladder tumor with a palpable mass in an adult and comment on the possible etiology.

Eosinophilic cystitis: a therapeutic challenge

Eosinophilic cystitis is a rare disease with only 42 cases reported since first described in 1960. We report a case in a twenty-four-year-old woman and present the different therapeutic alternatives. A review of all reported cases shows that except for children and male adults with benign prostatic hypertrophy, this is a chronic inflammatory process of unknown causation for which no specific therapy is available.

Eosinophilic cystitis in children: a self-limited process

We report a case of eosinophilic cystitis in a 7-year-old boy. Bilateral hydronephrosis and a lesion involving most of the bladder were seen initially. Complete resolution of all symptoms occurred within 3 weeks and the x-ray findings returned to normal in 6 weeks without specific therapy. A review of all reported cases of eosinophilic cystitis in children suggests that, unlike in adults, the disease is self-limited.

Eosinophilic cystitis: advanced disease requiring surgical intervention

Eosinophilic cystitis, a rare disease of unknown origin, simulates bladder neoplasms and interstitial cystitis. Since the first report by Brown in 1959, 35 additional cases have appeared in the literature. Reported here are 3 cases with advanced forms of this disease which failed to respond to antibiotics, antihistamines, steroids, fulguration, and, finally were subjected to cystectomy and urinary diversion after periods of five to fifteen years.

Histamine receptors in urethrovesical smooth muscle

Through the method of pharmacologic antagonism, the contractile effect of histamine was studied simultaneously on isolated smooth muscle preparations obtained from the body and base of the bladder and from the proximal urethra of the guinea pig. Histamine had a contractile effect mediated specifically through H1 receptors, with no H2 activity. This effect was most marked in the body of the bladder, comparatively moderate in the base, and slight in the proximal urethra. It appears that histamine effect is not mediated through either a cholinergic or an adrenergic mechanism. Clinical implications are discussed.