Eosinophilic cystitis: three cases, and a review over 10 years

The clinical and imaging features of eosinophilic cystitis in children: a case series study

BACKGROUND

Eosinophilic cystitis (EC) is rare in children and remains poorly understood. Our aim was to analyse the clinical and imaging features of eosinophilic cystitis in children.

METHODS

A retrospective review of histologically confirmed eosinophilic cystitis between January 2008 and December 2022 was performed, including patient age, sex, symptoms, laboratory examination, radiology, treatment and outcome.

RESULTS

Twelve children (two girls, 10 boys; age range: 3-12 years, mean age: 7.2 years) were included in the study. Urinary irritation symptoms (10/12), haematuria (5/12) and hypogastralgia (3/12) were the most common symptoms. Five patients had a history of allergies, six patients had elevated serum IgE, nine patients had elevated peripheral eosinophils and six patients had positive microscopic haematuria. Radiology revealed diffuse homogeneous or inhomogeneous thickening in seven patients, localised thickening in three patients, and solitary tumour-like lesions in the other two patients. Preservation of the mucosal line and bladder wall layering were observed in eleven patients, and perivesical exudation and small vessel dilatation were observed in ten patients. All four patients with delayed scans showed obvious delayed enhancement. One patient showed low signal intensity on T2-W imaging. All patients received antihistamine, antibiotic and/or corticosteroid therapy and two tumour-like patients underwent transurethral resection. Nine patients achieved complete response and three patients achieved partial response.

CONCLUSION

The clinical and imaging manifestations of EC in children have relative characteristics; when urologist and radiologist confronted with similar cases, EC should be considered. The final diagnosis depends on pathological biopsy.

Eosinophilic cystitis: a case report of a pseudotumoral lesion

Eosinophilic cystitis is a rare inflammatory disorder of the bladder, characterized by eosinophilic infiltration of the bladder wall, fibrosis of the mucosa, and muscle necrosis. Ultrasonography, when performed, shows a pseudotumoral mass that can be mistaken for malignancy. We report a case of a woman referred to our department in which an ultrasound showed a bladder mass and the biopsy demonstrated the presence of eosinophilic cystitis. The patient was treated with medical treatment and the outcome was favorable with the disappearance of symptoms and no recurrence at controls. We carry a literature review of cystitis eosinophilic, the ultrasound appearance, and therapeutic modalities.

A case of eosinophilic cystitis coexisting of superficial bladder cancer, mimicking muscle-invasive cancer

Introduction

Here, we present a rare case of eosinophilic cystitis coexisting with bladder cancer, which appeared to be an invasive carcinoma on imaging.

Case presentation

A 46-year-old man presented with urinary urgency. Computed tomography revealed an irregular and thickly enhanced bladder wall, which seemed to be invasive bladder cancer. Cystoscopy revealed a raspberry-like mass lesion on the entire bladder circumference. Pathological diagnosis after transurethral resection was pathological T1 urothelial carcinoma. After a thorough discussion of treatment options, the patient elected to receive intravesical Bacillus Calmette-Guérin. Three months after Bacillus Calmette-Guérin administration, no residual disease was confirmed by transurethral biopsy, and no recurrence was observed over 2 years. As peripheral eosinophilia and submucosa eosinophil infiltration were identified, the patient was diagnosed with coexisting eosinophilic cystitis and urothelial carcinoma.

Conclusion

Clinicians should consider the possibility of eosinophilic cystitis with superficial bladder cancer coexistence in patients who present with an irregular and thick bladder wall.

Correlation of urinary catheterization with histologic grading of eosinophilic cystitis: a single institutional review of 27 cases

Eosinophilic cystitis (EC) is an uncommon diagnosis, mimicking urothelial carcinoma. Multiple etiologies including iatrogenic, infectious, and neoplastic have been suggested, effecting both adults and pediatric population. A retrospective clinicopathologic review of patients with EC in our institution between 2003 and 2021 was conducted. Age, gender, presenting symptoms, cystoscopic findings, and history of urinary bladder instrumentation were recorded. Histologically, urothelial and stromal changes were noted, and mucosal eosinophilic infiltration was graded as mild (scattered eosinophils in the lamina propria), moderate (visible small clusters of eosinophils without brisk reactive changes), or severe (dense eosinophilic infiltrate with ulcer formation and/or muscularis propria infiltration). Twenty-seven patients (male to female ratio = 18/9, median age 58 [12-85 years]), of whom two were in the pediatric age group were identified. Leading presenting symptoms were hematuria (9/27, 33%), neurogenic bladder (8/27, 30%), and lower urinary tract symptoms (5/27, 18%). Four of 27 (15%) patients had history of urothelial carcinoma of urinary bladder. Cystoscopy commonly revealed erythematous mucosa (21/27, 78%) and/or urinary bladder mass (6/27, 22%). Seventeen of 27 (63%) of patients had history of long-term/frequent catheterization. Mild, moderate, and severe eosinophilic infiltrates were seen in 4/27 (15%), 9/27 (33%), and 14/27 (52%) of cases. Proliferative cystitis (19/27, 70%) and granulation tissue (15/27, 56%) were additional common findings. All cases of long-term/frequent instrumentation cases had moderate or severe eosinophilic infiltrate. EC should be in the differential diagnosis; particularly in patients with long term/frequent catheterization.

A rare presentation of eosinophilic cystitis in paediatric urology

Eosinophilic cystitis (EC) is a rare inflammatory condition of the urinary bladder. It is extremely rare in childhood and may present with haematuria, lower abdominal mass or recurrent urinary tract infections. We present the case of a 5-year-old girl with recurrent, painless visible haematuria. Ultrasound showed a bladder mass and left hydronephrosis. Cystoscopy and bladder biopsy confirmed the diagnosis. The patient was successfully managed with oral treatment. In the case of EC, cystoscopy and bladder biopsy is key for diagnosis. Conservative management of unilateral hydronephrosis in EC is appropriate and we advise oral corticosteroids in its treatment.

Refractory eosinophilic cystitis controlled with low-dose cyclosporine therapy: A case report

Eosinophilic cystitis (EC) is a rare disease of the bladder with no clear inciting etiology, pathogenesis, or standard treatment. We present the case of a 78-year-old woman with a three-year history of refractory EC with symptoms characterized by urinary frequency, gross hematuria, dysuria, and suprapubic pain. Despite treatment with a silver nitrate instillation, antibiotics, alpha-1 blockers, antihistamines, antimuscarinics, beta-3 agonists, and intravesical steroid injections, her symptoms persisted. She was then trialed on systemic therapies including prednisone, montelukast, and cyclosporine. Upon follow-up after initiation of therapy with low-dose cyclosporine she had an excellent response, both symptomatically and anatomically via cystoscopy.

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.

Successful treatment of eosinophilic cystitis with benralizumab

Eosinophilic cystitis is a rare form of interstitial cystitis. It can be chronic and debilitating due to urinary frequency, dysuria, incontinence, and frequent urinary tract infections. Prior attempts at treatment have included oral and intravesical steroids, antispasmodics, and antibiotics when indicated. Treatment of eosinophilic disorders has recently been improved with the use of monoclonal antibodies directed at interleukin 5. We report here a case of eosinophilic cystitis treated with the interleukin 5 antagonist, benralizumab. The patient had significant improvement in both quality of life measures and biopsy findings.

Eosinophilic cystitis caused by Candida glabrata: A case report

Eosinophilic cystitis is a rare disease of the bladder, for which there is no clear cause or standard treatment. We report the case of a 61 year old man who presented with irritative voiding symptoms and gross hematuria. Cystoscopy showed diffuse urothelial erythema and a posterior bladder wall ulcer. Bladder biopsy revealed marked eosinophilic cystitis with ulceration. Urine culture grew Candida glabrata. After treatment with oral fluconazole, his voiding symptoms resolved and subsequent bladder biopsy revealed a complete dearth of eosinophils. This is the first case report linking eosinophilic cystitis to Candida glabrata.

Transplant immunosuppressive drugs in urology

Immunosuppressive drugs are used in renal transplantation to prevent and treat rejection and their use has traditionally been limited to urologists trained in transplant surgery. However, there are other urologic conditions for which these drugs have proven efficacy. Since transplant surgery has become a small niche subspecialty within urology, most urologists are unfamiliar and uncomfortable with their use. This review will focus on the use of Cyclosporine (CyA), mycophenolate mofetil (MMF), and mammalian target of rapamycin (mTOR) inhibitors in urology outside of solid organ transplant. This includes the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) with CyA as well as the role of CyA in eosinophilic cystitis (EC) and the treatment of retroperitoneal fibrosis (RF) with MMF. Also included is the utilization of mTOR inhibitors in both advanced renal cell carcinoma (RCC) and in patients with tuberous sclerosis complex (TSC) associated angiomyolipoma (AML). Available clinical data on mTOR inhibition in autosomal dominant polycystic kidney disease (ADPKD) is also briefly presented. Specific attention is given to the indications for each agent, the available evidence surrounding their use, and the most common adverse events (AEs) and their subsequent management.

[A CASE REPORT: EOSINOPHILIC CYSTITIS PRESENTED WITH DEEP VEIN THROMBOSIS]

A 76-year-old man presented with gross hematuria and reported the use of anticoagulant for deep vein thrombosis (DVT). Blood tests revealed eosinophilia and thrombocytopenia. Urine cytology revealed a class I specimen with a few eosinophils in the urine. We performed cystoscopy, which revealed bladder masses with friable mucosa diffusely throughout the bladder. Magnetic resonance imaging revealed possible invasion of the bladder muscle by the masses. We performed transurethral resection of the bladder masses, and histopathological examination revealed eosinophilic infiltration of the bladder wall stroma without cancerous tissue. Therefore, the patient was diagnosed with eosinophilic cystitis.Eosinophilia and thrombocytopenia promptly resolved, and the bladder masses disappeared following the administration of prednisolone for eosinophilic cystitis. DVT also improved without recurrence of eosinophilic cystitis.

Eosinophilic cystitis in children: A case report

The aim of the present case report was to investigate the clinical features, pathological examination and treatment of eosinophilic cystitis (EC) in children. Two cases of EC were reported and reviewed from January 2016 to March 2017. Case 1 (male; 6 years old) had intermittent hematuria, frequent urination, urgent urination, difficulty in urination and abdominal pain. Case 2 (male; 7 years old) had frequent urination, urgent urination, urinary pain, dysuria and suprapubic pain with no hematuria. One patient had a history of allergies and both patients underwent a cystoscope biopsy. Blood eosinophils were clearly increased and a bone marrow biopsy examination revealed that marrow eosinophils were also increased in both cases. The urine culture results were negative. Ultrasonography and computed tomography revealed uneven thickening of the bladder wall and diffusive mucosal lesions. Cystoscopy revealed that the bladder volume became smaller and the mucosa at the bladder floor and neck was red. Lesions were biopsied through the urethra and the following characteristics were observed: Congestion and edema of the bladder mucosa, infiltration of the blood vessels and eosinophils in the muscular layer, accompanied by focal muscle necrosis. Patient 1 was administered anti-inflammatory and cetirizine hydrochloride treatments, followed by 6 weeks of prednisone dose-reduction therapy. Patient 2 was administered antibiotics and cetirizine hydrochloride. Following 6-month follow-ups, abnormal voiding symptoms had disappeared in each case. Ultrasonography and computed tomography revealed no bladder wall thickening or space-occupying lesions. EC in children is rare and easily misdiagnosed as nonspecific bladder inflammation or bladder occupying lesions. Cystoscopy and biopsy are necessary to diagnose EC and conservative treatments with anti-inflammatory, anti-allergic and cortical hormone nonspecific treatments are suggested.

BRAF mutation as a novel driver of eosinophilic cystitis

Eosinophilic cystitis is a rare manifestation of hypereosinophilia and a cause of morbidity, including dysuria and hematuria. Although some cases can be attributed to infection or allergy, most cases are assessed to be idiopathic and treated with corticosteroids. However, hypereosinophilia can also be due to actionable clonal molecular alterations in the haematopoietic cells, similar to other myeloproliferative neoplasms. Common mutations associated with eosonophilic syndromes are of platelet-derived growth factor receptor α or β or c-kit, though other pathogenic mutations have been found by next generation sequencing. Determination of a specific mutation may therefore identify clonality and refine treatment of some cases. Here we review the molecular features of eosinophilic disorders. We also describe the use of a liquid biopsy of circulating cell-free DNA in the workup of a case of eosinophilic cystitis in which next generation sequencing of cell-free DNA showed a BRAF I463T mutation. In silico modeling supports the functional impact and potential clinical relevance of BRAF I463T.

Eosinophilic cystitis with recurrent urinary retention: case report

Eosinophilic cystitis is a rare inflammatory disease of the bladder whose origin, pathogenesis, and treatment are unknown. Frequency, dysuria, and hematuria are frequent symptoms. Here, we report a rare occurrence of recurrent urinary retention and repetitive catheterization. A 67-year-old male presented with acute urinary retention and intermittent gross hematuria of 2 weeks duration. Urethral catheterization followed by a trial without catheter, was successful. Complete blood count showed presence of eosinophils (eosinophilia) and computed tomography of kidneys, ureter and bladder with contrast showed thickened bladder wall and small prostate. Cystoscopy revealed an erythematous lesion over the anterior wall. The rest of the mucosa was normal. Transurethral biopsies of the lesion were performed and histologic examination showed features of eosinophilic cystitis. Despite multiple medication regimens containing corticosteroids and antihistamines, he presented with recurrent urinary retention, approximately once every month. After 6 months, he was started on bethanechol, which led to no catheterization for up to 2 years. To the best of our knowledge, this is the first report on the successful use of bethanechol as a treatment for eosinophilic cystitis with recurrent urinary retention.