A case of eosinophilic cystitis

A 67-year-old man presented with pollakisuria, and miction pain. The patient who had superficial bladder cancer was treated with transurethral resection and instillation of Pirarubicin hydrochloride. Urinalysis revealed a marked increase in eosinophilic cells. A cystoscopic examination revealed an ischemic lesion and hypervascular lesion throughout the bladder. Histological findings of biopsied bladder specimens showed eosinophilic cystitis. Bladder symptoms are improved with steroid administration.     

Recurrent eosinophilic cystitis with peripheral eosinophilia and hyperimmunoglobulinemia E

A case of recurrent eosinophilic cystitis with peripheral eosinophilia and hyperimmunoglobulinemia E, which responded successfully to initial and secondary steroid therapies is reported.     

A case of eosinophilic cystitis in a 5-year-old boy

Eosinophilic cystitis (EC) is rather an uncommon disease in childhood. A case of EC in a 5‐year‐old boy, in which open biopsy was needed for final diagnosis, is reported. After diagnosis, he was treated with pemirolast potassium followed‐up with eosinophil cationic protein (ECP) in serum and urine. Eosinophil cationic protein is an appropriate marker of EC.     

A case of eosinophilic cystitis with retroperitoneal neurinoma

A 63-year-old female visited our department, complaining of miction pain. She had several episodes of urinary occult blood. Urinalysis included a small number of red cells, white cells and bacilli. Physical examination revealed a fist-sized mass of her right flank. Cystoscopic examination showed a botryoid tumor with multiple erythematous raised plaques. Biopsy was reported as massive infiltration of eosinophiles in submucosal layer of the bladder, i.e. eosinophilic cystitis. Antibiotics were effective for the improvement of urine findings and symptoms within a week. IVP and CT revealed the abdominal mass as a retroperitoneal tumor with cystic degeneration, and the tumor was resected. Pathological diagnosis was benign neurinoma. Both eosinophilic cystitis and retroperitoneal neurinoma are rare, and the concurrent occurrence of these two diseases has not been reported. Recent studies have suggested that eosinophilic cystitis may occur more frequently than suspected, and may be overlooked clinically and microscopically. This uncommon form of cystitis should be considered in the differential diagnosis especially when the patient has unexplained episodes of bladder symptoms and hematuria.     

Contracted bladder secondary to eosinophilic cystitis

International Urology and Nephrology -     

A case of eosinophilic cystitis presenting with urinary retention

A 56-year-old woman was referred to our hospital presenting with urinary retention. Ultrasonography revealed bilateral hydronephrosis and magnetic resonance imaging of the pelvis showed diffuse thickening of the bladder wall. The hydronephrosis was improved by urethral balloon catheter. A cystoscopic examination revealed papillary lesions, polypoid yellow lesions and gross mucosal edema in the whole bladder. Pathological examination of transurethral punch biopsy showed no malignancy but inflammatory infiltration in the submucosa of bladder wall with many eosinophils. She performed clean intermittent self-catheterization and was treated with corticosteroids and antihistaminics. Three months after diagnosis, conservative treatment resulted in an excellent relief of symptoms, decrement of residual urine and remission of the bladder lesions in cystoscopy. In women with urinary retention, eosinophilic cystitis (EC) must be considered in the differential diagnosis. To our knowledge, this is the first case of EC presenting with urinary retention reported in the Japanese literature.     

Emphysematous cystitis: report of a case.

Emphysematous cystitis is characterized by gas collection within the bladder wall and lumen. A case of emphysematous cystitis in a 74-year-old diabetic male is reported. Radiogram demonstrated an enlarged bladder with intraluminal gas.     

A case report of eosinophilic cystitis complicated with transient vesicoureteral reflux

A case of eosinophilic cystitis complicated with transient vesicoureteral reflux in an 11-year-old girl with allergic disorders is reported. She was suffering from pollakisuria, painful urination, vesical irritability, and gross hematuria for about 2 months. Urinalysis showed aseptic pyuria. White blood cell count was 9,700/mm3 with eosinophils of 10%. Eosinophils were also found on urine cytology. Intravenous pyelography revealed bilateral hydronephrosis and apparently contracted bladder. Tumorous lesion and edematous mucosa were observed in the retrotrigonal region on cystoscopy. The multiple bladder biopsy uniformly revealed eosinophilic cystitis. Following antiallergic treatment, practically all symptoms subsided in steps, and normal cystoscopic appearance and histological structure were restored in 3 months. The vesicoureteral reflux markedly diminished in 10 months.     

Recurrent flank pain caused by eosinophilic ureteritis mimicking urinary stone disease: a case report

Flank pain is caused by a variety of pathologies of which urinary stone disease is the most frequent. Eosinophilic ureteritis is a rare stenosing condition of the ureter. Eosinophilic ureteritis can cause flank pain and/or unilateral hydronephrosis. On pathological examination it is characterised by a marked infiltration of the submucosal layers by eosinophils. A relationship of this condition with atopy, hypereosinophilic syndrome and prior ureteral trauma has been described. Surgical resection of the stenosing segment with end-to-end anastomosis is usually a successful treatment. In some cases of proximal disease total nephro-ureterectomy has been performed. One author describes remission of disease after a prolonged oral corticosteroid regimen. In this article we report another case of eosinophilic ureteritis and discuss different treatment strategies.     

Recurrent cystitis and crenotherapy. 302 cases

This article analyzes a series of 302 female patients prone to cystitis. The fact that these women were seen in a urological crenotherapy center highlights the very evolutive nature of the disease. The high rate of E coli present in the urine should be noted. Most of the women had a normal intravenous urogram and a normal endoscopy. The "classic" causes are rarely responsible for attacks of cystitis, but sexual intercourse and pregnancy seem to play a part. Several of the women took estroprogestative pills, or wore an intra-uterine device. The rate of bowel symptomatology-colopathy or constipation--should be noted. The article assesses the evolution of cystitis before and after crenotherapy at La Preste.     

Two cases of eosinophilic cystitis induced by tranilast.

We report 2 cases of eosinophilic cystitis induced by Tranilast, which was used for the treatment of bronchial asthma. In case 2 Tranilast itself and its metabolic derivative proved to be inciting agents by a drug-induced lymphocyte stimulation test. The literature on this association is reviewed.     

Severe eosinophilic cystitis in a woman with anorexia nervosa

Eosinophilic cystitis is a rare inflammatory disorder. It is considered to be self limiting necessitating only supportive therapy. Surgical intervention is unusual. We report here an association between eosinophilic cystitis and anorexia nervosa in an adult woman requiring radical surgery for progressive relentless disease. Estrogen deficiency associated with a possible allergic etiology could explain this association.     

Recurrent hemolytic-uremic syndrome: a case report.

A girl who developed HUS at 2 years of age had four further episodes of the disease during the next 2 1/2 years. No renal or hematologic abnormalities were detected during or between the attacks. Reduced levels of serum complement were found during three of the episodes.     

A case of emphysematous cystitis: a case report

A 86-year-old woman presented with asymptomatic gross hematuria,and visited our hospital, and a vesicorectal fistula was suspected from a computed tomographic (CT) scan. She had a lower abdominal mass and urinary retention on arrival. Pclvic CT demonstrated intramural gas in the urinary bladder,which suggested a diagnosis of emphysematous cystitis. Cystoscopy demonstrated reddish mucosa and gas within the bladder wall. The gross hematuria was improved and the intramural gas disappeared on a CT scan after urinary drainage and antibiotic therapy. Although emphysematous cystitis is almost always cured with conservative therapy, an accurate diagonosis and prompt treatment are required because rarely emphysematous cystitis can result in rupture of the urinary bladder and lead to septic shock.     

A case of emphysematous cystitis : a case report

Emphysematous cystitis is a rare lower urinary tract infection. A case of emphysematous cystitis with diabetes mellitus and transverse colon cancer is reported. The patient was an 81-year-old woman complaining of nausea and vomiting. Urinalysis showed hematopyuria. Plain abdominal film and CT scan showed gaseous shadow in the bladder wall. Urine culture contained Escherichia coli. A urethral catheterization and administration of antibiotics resulted in the marked improvement in the clinical course. To our knowledge, 53 cases of emphysematous cystitis have been reported in the Japanese literature including this case and the clinical features are reviewed.     

Atorvastatin-induced hemorrhagic cystitis: a case report

The first case of hemorrhagic cystitis due to atorvastatin for treatment of hyperlipidemia is reported. Hematuria resolved spontaneously with discontinuation of the drug.     

Emphysematous cystitis. Apropos of a case]

Emphysematous cystitis is a rare complication of lower urinary tract infection, occurring almost exclusively in diabetic women. The prognosis, usually good, depends on early diagnosis and prompt treatment which consists of urinary drainage, antibiotic therapy and strict blood glucose control. The authors report a case of emphysematous cystitis diagnosed on laparotomy for acute abdomen. Death occurred despite treatment.     

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.     

Diagnosis and management of eosinophilic cystitis: a pooled analysis of 135 cases

OBJECTIVE: Eosinophilic cystitis is a rare disease. We reviewed the literature for clinical presentation, diagnosis and therapeutic options to establish recommendations for diagnostic and therapeutic management. METHODS: A pooled analysis was performed of 135 patients with eosinophilic cystitis presented in the literature. The evaluation included patient age, sex and race, presenting symptoms, diagnostic examinations, treatment and results, and complications. RESULTS: The mean age at diagnosis was 41.6 years (range 5 days to 87 years). An equal distribution existed between males (44%) and females (35%), but in children (21%) boys were more often affected (14%) than girls (7%). The most common presenting symptoms were frequency (67%), dysuria (62%), gross/microscopic hematuria (68%), suprapubic pain (49%) and urinary retention (10%). All patients had a cystoscopy and biopsy; a biopsy is mandatory to establish the diagnosis. Positive urine cultures were found in 26% of the patients. Periferal eosinophilia was present in 43%. An intravenous urography was performed in 66%, ultrasonography in 15%, cystography in 23% and a CT scan in 10%. The majority of patients was treated with combinations of corticosteroids, antihistaminics and antibiotics (45%), avoiding of the suspected antigen (17%), transurethral resection of the lesions (9%), partial cystectomy (4%) or total cystectomy (4%). The success rates for the different treatments were variable: transurethral resection combined with corticosteroids, antihistaminics or antibiotics seemed most successful, while total cystectomy is reserved for patients with unresponsive disease and hematuria. The most common complications were dilation of the upper urinary tract (27%) and eosinophilic gastroenteritis (4.5%); all other complications occurred in less than 3% of the patients. CONCLUSION: Eosinophilic cystitis is equally distributed among the sexes, but in children boys are affected more often than girls. The presenting symptoms are frequency, dysuria, hematuria, suprapubic pain and urinary retention. The treatment of choice is (radical) transurethral resection of the lesions in the bladder and a combination of corticosteroids and antihistaminics. Antibiotics are given when a urinary tract infection is present, or when dilation of the upper urinary tract exists. Most patients are cured but recurrence is a frequent finding.