1
|
Adeleye O, Trickett JS, Wright BL, Khan A. Refractory eosinophilic cystitis controlled with low-dose cyclosporine therapy: A case report. Urol Case Rep 2021; 39:101829. [PMID: 34522620 PMCID: PMC8424508 DOI: 10.1016/j.eucr.2021.101829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/25/2021] [Accepted: 08/29/2021] [Indexed: 12/02/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - John S Trickett
- Internal Medicine Residency, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Benjamin L Wright
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA.,Section of Allergy and Immunology, Division of Pulmonology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Aqsa Khan
- Division of Urology, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| |
Collapse
|
2
|
Abstract
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.
Collapse
Affiliation(s)
- Alice Crane
- Glickman Urological and Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Eltemamy
- Glickman Urological and Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Shoskes
- Glickman Urological and Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
3
|
Kilic O, Akand M, Gul M, Karabagli P, Goktas S. Eosinophilic Cystitis: A Rare Cause of Nocturnal Enuresis in Children. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e24562. [PMID: 27621918 PMCID: PMC5002967 DOI: 10.5812/ircmj.24562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 03/25/2015] [Accepted: 05/17/2015] [Indexed: 12/05/2022]
Abstract
Introduction Eosinophilic cystitis (EC) is a rare and poorly understood inflammatory condition, characterized by eosinophilic infiltration of all layers of the bladder wall, which mimics bladder tumors. EC may present with symptoms such as increased urination frequency, dysuria, gross/microscopic hematuria, suprapubic pain and urinary retention. Case Presentation We present a 17-year-old male patient, who was continent night and day in his childhood, and was admitted to our clinic for complaints of hematuria and nocturnal enuresis for the past six months. His history and physical examination were unremarkable, and routine hematological and biochemical tests were normal. Cystoscopy revealed a 4 × 3 cm erythematous, polypoidal, solid lesion on the bladder dome. Histopathological examination of the lesion revealed transitional epithelium with stromal edema, where diffuse, dense infiltration of lamina propria by eosinophils and lymphocytes was also seen. According to these findings, a histopathological diagnosis of EC was made, and the patient was treated with corticosteroids, antimicrobial agents and antihistamines. His symptoms dramatically improved and nocturnal enuresis also recovered after treatment. Conclusions Although it is a rare entity, EC should be kept in mind in the differential diagnosis of patients presenting with dysuria, hematuria and any kind of acquired voiding dysfunction, including frequency, pollakiuria and incontinence.
Collapse
Affiliation(s)
- Ozcan Kilic
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Murat Akand
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
- Corresponding Author: Murat Akand, Department of Urology, School of Medicine, Selcuk University, Konya, Turkey. Tel: +90-5327438333, Fax: +90-3322412184, E-mail:
| | - Murat Gul
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Pinar Karabagli
- Department of Pathology, School of Medicine, Selcuk University, Konya, Turkey
| | - Serdar Goktas
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| |
Collapse
|
4
|
Aleem S, Kumar B, Fasano MB, Takacs E, Azar AE. Successful use of cyclosporine as treatment for eosinophilic cystitis: a case report. World Allergy Organ J 2016; 9:22. [PMID: 27458500 PMCID: PMC4939020 DOI: 10.1186/s40413-016-0113-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/24/2016] [Indexed: 11/21/2022] Open
Abstract
Background Eosinophilic cystitis is a rare inflammatory disorder characterized by eosinophilic infiltration of all layers of the urinary bladder wall. Due to lack of consensus and potential for side effect from various therapeutic options, treatment of the disease is often challenging. Case presentation A 64-year old woman with hypertensive nephropathy resulting in stage III chronic kidney disease, obstructive sleep apnea, and obstructive lung disease presented with a 4 month history of dysuria, urgency, frequency, and persistent hematuria. Based on eosinophilic infiltration on bladder wall biopsy in the absence of any evidence of infection, malignancy, or immune disorder, she was diagnosed with eosinophilic cystitis. Despite multiple medication regimens, her symptoms persisted, requiring high-dose prednisone with steroid-related side effects. After four months, she was started on cyclosporine, which led to symptomatic improvement and reduction in prednisone dosage. At that time, repeat urine cytology and cystoscopy did not reveal friable tissues or eosinophiluria. Conclusion This case illustrates the utility of using cyclosporine to treat eosinophilic cystitis in adult patient with multiple comorbid conditions.
Collapse
Affiliation(s)
- Sohaib Aleem
- Division of Immunology, University at Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA ; Division of Immunology, Department of Internal Medicine - C42 GH, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Bharat Kumar
- Division of Immunology, University at Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Mary Beth Fasano
- Division of Immunology, University at Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Elizabeth Takacs
- Department of Urology, University at Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Antoine Emile Azar
- Division of Immunology, University at Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA ; Present address: Division of Allergy and Clinical Immunology, John Hopkins Asthma & Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224 USA
| |
Collapse
|
5
|
Ozdoğan EB, Arslansoyu Çamlar S, Bilen S, Imamoğlu M, Tıraş S, Cansu A, Ozoran Y. An unusual cause of terminal hematuria in a child: Eosinophilic cystitis. Can Urol Assoc J 2014; 8:E867-71. [PMID: 25485018 DOI: 10.5489/cuaj.2173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Elif Bahat Ozdoğan
- Department of Pediatrics, Division of Pediatric Nephrology, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Seçil Arslansoyu Çamlar
- Department of Pediatrics, Division of Pediatric Nephrology, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Sevcan Bilen
- Department of Pediatrics, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Mustafa Imamoğlu
- Department of Pediatric Surgery, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Sükran Tıraş
- Department of Pediatrics, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Ayşegül Cansu
- Department of Radiology, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Yavuz Ozoran
- Department of Medical Pathology, Faculity of Medicine, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| |
Collapse
|
6
|
Das CJ, Ahmad Z, Sharma S, Gupta AK. Multimodality imaging of renal inflammatory lesions. World J Radiol 2014; 6:865-873. [PMID: 25431641 PMCID: PMC4241493 DOI: 10.4329/wjr.v6.i11.865] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 04/30/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Spectrum of acute renal infections includes acute pyelonephritis, renal and perirenal abscesses, pyonephrosis, emphysematous pyelonephritis and emphysematous cystitis. The chronic renal infections that we routinely encounter encompass chronic pyelonephritis, xanthogranulomatous pyelonephritis, and eosinophilic cystitis. Patients with diabetes, malignancy and leukaemia are frequently immunocompromised and more prone to fungal infections viz. angioinvasive aspergillus, candida and mucor. Tuberculosis and parasitic infestation of the kidney is common in tropical countries. Imaging is not routinely indicated in uncomplicated renal infections as clinical findings and laboratory data are generally sufficient for making a diagnosis. However, imaging plays a crucial role under specific situations like immunocompromised patients, treatment non-responders, equivocal clinical diagnosis, congenital anomaly evaluation, transplant imaging and for evaluating extent of disease. We aim to review in this article the varied imaging spectrum of renal inflammatory lesions.
Collapse
|
7
|
Claps A, Della Corte M, Gerocarni Nappo S, Francalanci P, Palma P, Finocchi A. How should eosinophilic cystitis be treated in patients with chronic granulomatous disease? Pediatr Nephrol 2014; 29:2229-33. [PMID: 25037864 DOI: 10.1007/s00467-014-2883-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/30/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic granulomatous disease (CGD) is a primary immunodeficiency resulting from the absence or malfunction of oxidative mechanism in phagocytic cells. The disease is due to a mutation in one of four genes that encode subunits of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex. Affected patients experience severe infections and granuloma formation due to exuberant inflammatory responses. Some evidence suggests that eosinophilic cystitis (EC) is included in the spectrum of inflammatory manifestations. EC is an inflammatory disease, rare in childhood, which may require different, nonstandardized therapeutic approaches, ranging from antihistamines to cyclosporine. CASE-DIAGNOSIS/TREATMENT Herein we describe the cases of two CGD patients with CGD who experienced EC during hospitalization for a severe infection. CONCLUSIONS EC in immunocompetent children seems to have a self-limiting course, unlike in CGD patients, in whom it presents a prolonged and recurrent course. We focus on the effective therapy administered to our patients with CGD and review the corresponding literature.
Collapse
Affiliation(s)
- Alessia Claps
- Unit of Immunology and Infectious Diseases, University-Hospital Pediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | | | | | | | | |
Collapse
|
8
|
Piedade C, Ramos M, Heitor F, Castro L, Ochoa de Castro A. Cistitis eosinofílica. Causa rara de disuria. An Pediatr (Barc) 2014; 80:e29-30. [DOI: 10.1016/j.anpedi.2013.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/11/2013] [Accepted: 04/16/2013] [Indexed: 11/12/2022] Open
|
9
|
D M, T M K, M S, V R M, V G. Eosinophilic cystitis mimicking bladder tumour - a rare case report. J Clin Diagn Res 2013; 7:2282-3. [PMID: 24298501 DOI: 10.7860/jcdr/2013/6018.3496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/01/2013] [Indexed: 11/24/2022]
Abstract
A 16-year-old male presented with urinary urgency, a frequency of 4 months duration and intermittent gross haematuria which were there since one month. Eosinophilia was noted in complete blood count and CT KUB with contrast showed a filling defect in the right lateral wall, over the vesicoureteric junction. Cystoscopy revealed a sessile mass lesion over right vesico-ureteric junction, with bullous oedema . Rest of the mucosa was normal. Transurethral resection of lesion was performed and histological examination showed features of eosinophilic cystitis. Patient was treated with corticosteroids, antimicrobial agents and antihistaminics and he is recovering well. We are presenting this case for its rare presentation and its possibility of mimicking a bladder tumour. Biopsy of the lesion was diagnostic and an early treatment showed good results.
Collapse
Affiliation(s)
- Manimaran D
- Associate Professor, Department of Pathology, Melmaruvathur Adhiparasakthi Institute of Medical Sciences & Research , Tamilnadu, India
| | | | | | | | | |
Collapse
|
10
|
Sparks S, Kaplan A, DeCambre M, Kaplan G, Holmes N. Eosinophilic cystitis in the pediatric population: a case series and review of the literature. J Pediatr Urol 2013; 9:738-44. [PMID: 23391564 DOI: 10.1016/j.jpurol.2012.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 11/06/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE Eosinophilic cystitis is a rarely seen condition in the pediatric population with indistinct symptomatology and non-standardized treatment protocols. We review our experience of treating patients with this condition. MATERIALS AND METHODS We retrospectively reviewed the records of four patients from a single institution who have been diagnosed and treated for eosinophilic cystitis. In addition, the literature was reviewed for cases of pediatric eosinophilic cystitis. Our patients were added and compared to this cohort. RESULTS Our patients included 3 females and 1 male who range in age from 5 days to 18 years (5 days, 1 month, 7 years, 18 years). Both of the infants presented with a suprapubic mass and bilateral hydroureteronephrosis. The two older patients both had dysuria while the 18 yo also complained of fatigue, flank pain, and hematuria. Only 2 of the 4 patients were found to have significant peripheral eosinophilia and only one patient had eosinophiluria. All of the patients were diagnosed via cystourethroscopy with biopsy. Treatment in each case consisted of a combination of steroids, antihistamines, and antibiotics. CONCLUSIONS The presentation of eosinophilic cystitis is varied and diagnosis requires a high index of suspicion. Cystourethroscopy with biopsy is essential to establish the diagnosis as there is no typical appearance of the lesions or presenting signs/symptoms. Most cases of eosinophilic cystitis are responsive to medical therapy although in some cases recurrence may be noted.
Collapse
Affiliation(s)
- S Sparks
- Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010, USA.
| | | | | | | | | |
Collapse
|
11
|
Eosinophilic cystitis with eosinophilic cholecystitis: a rare association. Case Rep Urol 2013; 2013:146020. [PMID: 24195001 PMCID: PMC3806378 DOI: 10.1155/2013/146020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/17/2013] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
|
12
|
Kojima K, Maeda J, Mikami S, Yamagishi H, Ide H, Hattori S, Takahashi T, Awazu M. Eosinophilic cystitis presented as a manifestation of hypereosinophilic syndrome: a case report and review of the literature. NEPHRON EXTRA 2013; 3:30-5. [PMID: 23573073 PMCID: PMC3618051 DOI: 10.1159/000346713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypereosinophilic syndrome (HES) is a group of disorders marked by the sustained overproduction of eosinophils, in which eosinophilic infiltration and inflammatory substance release cause damage to multiple organs. Eosinophilic cystitis (EC) is an inflammatory disorder caused by eosinophilic infiltration of the bladder wall. Although EC is often associated with eosinophilia, it has been rarely reported as a manifestation of HES. We report a case of EC as a primary manifestation of HES. The patient was a 27-year-old male with a history of complete intracardiac repair of tetralogy of Fallot who presented with an acute onset of dysuria accompanied by eosinophilia (7.5 × 10(3)/μl, 60% of white blood cells). Ultrasonography and MRI of the bladder showed a bladder mass, a biopsy of which revealed eosinophilic infiltration and degranulation. METHODS We performed a literature search in PubMed from 2001 to 2012 to find patients with EC who may have had HES. RESULTS There were 4 patients with HES who had EC including the present case. Of 14 patients reported as EC in whom the eosinophil count was described, 5 had eosinophils of ≥1,500/μl. None of the 5 patients had secondary causes for eosinophilia. Of the 9 patients with definite or probable HES, 7 patients (78%) were male and 5 patients (56%) showed a concomitant eosinophilic gastrointestinal disorder. CONCLUSION HES may not be uncommon as the cause of EC. Thorough evaluation and close monitoring are warranted in EC patients with elevated eosinophils.
Collapse
Affiliation(s)
- Katsuaki Kojima
- Department of Pediatrics, School of Medicine, Keio University, Tokyo, Japan
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Abilov A, Ozcan R, Polat E, Dervişoğlu S, Emir H. Rare cause of dysuria: eosinophilic cystitis. J Pediatr Urol 2013; 9:e6-8. [PMID: 22652390 DOI: 10.1016/j.jpurol.2012.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
Abstract
Eosinophilic cystitis is an inflammatory condition characterized by eosinophilic infiltration of whole layers of the bladder wall. The condition occurs more commonly in adults. We report a case of eosinophilic cystitis mimicking a bladder tumor in a 5-year-old boy with symptoms of dysuria and urinary incontinence. The diagnosis was confirmed by histopathology and he underwent clinical treatment with trimethoprim-sulfamethoxazole and antihistamine (cetirizine). The symptoms fully resolved in follow up, which is continuing. Although very rare, eosinophilic cystitis should be considered in cases of dysuria and increased bladder wall thickness but no identified urinary tract infection.
Collapse
Affiliation(s)
- Agil Abilov
- Division of Pediatric Urology, Department of Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | | | | | | |
Collapse
|
14
|
Rossi E, Pavanello P, Marzola A, Franchella A. Eosinophilic cystitis and nephrogenic adenoma of the bladder: a rare association of 2 unusual findings in childhood. J Pediatr Surg 2011; 46:e31-e34. [PMID: 21496523 DOI: 10.1016/j.jpedsurg.2010.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/28/2010] [Accepted: 12/29/2010] [Indexed: 11/16/2022]
Abstract
Neither eosinophilic cystitis nor nephrogenic adenoma is often diagnosed in children, with few pediatric cases being reported in the literature. Although these maladies share the same predisposing conditions, namely, chronic irritation or injury to the urothelium and lower urinary tract and symptoms such as dysuria, hematuria, and urinary frequency, their concomitance is exceptional. Herein, we report the case of an 8-year-old boy with a previous history of bladder surgery presenting histologically diagnosed eosinophilic cystitis and nephrogenic adenoma.
Collapse
Affiliation(s)
- Enrica Rossi
- Pediatric Surgery Department, Sant'Anna Hospital, Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy.
| | - Piero Pavanello
- Pediatric Surgery Department, Sant'Anna Hospital, Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy.
| | - Andrea Marzola
- Institute of Pathology, University of Ferrara, Via Fossato di Mortara, 64, 44100 Ferrara, Italy.
| | - Andrea Franchella
- Pediatric Surgery Department, Sant'Anna Hospital, Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy.
| |
Collapse
|
15
|
Galutira PJT, Canonigo BB, Cabansag MRF, Bolong DT, Ong RC, Lopez RA. Presenting manifestations of eosinophilic cystitis in two Filipino children. Int Urol Nephrol 2009; 42:557-63. [PMID: 19866369 DOI: 10.1007/s11255-009-9665-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 10/02/2009] [Indexed: 11/27/2022]
Abstract
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.
Collapse
Affiliation(s)
- Paul Joseph T Galutira
- Section of Pediatric Nephrology, University of Santo Tomas Hospital, Manila, Philippines.
| | | | | | | | | | | |
Collapse
|
16
|
Ebel Sepulveda LF, Foneron A, Troncoso L, Cañoles R, Carrasco C, Hornig A, Gil G, Corti D. [Eosinophilic cystitis: review and two case reports]. Actas Urol Esp 2009; 33:443-6. [PMID: 19579899 DOI: 10.1016/s0210-4806(09)74174-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- Luis F Ebel Sepulveda
- Servicio de Urología, Hospital Regional de Valdivia y Departamento de Urologia, Universidad Austral de Chile.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Tamai K, Koyama T, Saida S, Nishikomori R, Togashi K. MR imaging findings of eosinophilic cystitis in an 8-year-old girl. Pediatr Radiol 2007; 37:836-9. [PMID: 17541780 DOI: 10.1007/s00247-007-0511-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 04/07/2007] [Accepted: 04/20/2007] [Indexed: 01/01/2023]
Abstract
Eosinophilic cystitis is a rare inflammatory condition of the urinary bladder of unknown aetiology and characterized by eosinophilic infiltration of the bladder wall. We report the unique MR findings of eosinophilic cystitis in an 8-year-old girl who presented with peripheral eosinophilia. MR imaging revealed smooth and nearly circumferential thickening of the bladder wall showing distinct low signal intensity on T2-weighted images, which may histologically represent high cellularity due to massive eosinophilic infiltration.
Collapse
Affiliation(s)
- Ken Tamai
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | |
Collapse
|
18
|
Thompson RH, Dicks D, Kramer SA. Clinical manifestations and functional outcomes in children with eosinophilic cystitis. J Urol 2006; 174:2347-9. [PMID: 16280840 DOI: 10.1097/01.ju.0000180423.06285.72] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Eosinophilic cystitis is a rare disorder, with fewer than 30 pediatric cases reported in the literature. We describe our experience with pediatric eosinophilic cystitis during a 20-year period. MATERIALS AND METHODS Four children referred to our institution were subsequently diagnosed with eosinophilic cystitis between 1984 and 2004. A retrospective chart review was performed to assess clinical presentation, diagnosis, treatment and outcomes. RESULTS Mean patient age at presentation was 10.8 years (range 5 to 18) and male-to-female ratio was 3:1. All 4 patients presented with irritative urinary symptoms, including 3 with dysuria and/or gross hematuria and 2 with urinary frequency, lower abdominal pain and/or a concomitant urinary tract infection. Allergic diseases (asthma, allergic rhinitis, etc) were present in 3 patients, and a formal allergen skin test was positive in 2 of those tested. A bladder mass mimicking malignancy was documented in 2 patients. Three patients had symptom resolution with conservative treatment, while 1 had development of an unremitting tumefactive process that eventually required partial cystectomy and bladder augmentation. CONCLUSIONS Eosinophilic cystitis is a rare condition with a wide range of clinical manifestations. Children can present with a bladder mass mimicking sarcoma, underscoring the need for biopsy before diagnosis and treatment of a presumed oncological process. The condition usually follows a benign course, although unremitting progression remains a possibility.
Collapse
Affiliation(s)
- R Houston Thompson
- Department of Urology, Mayo Medical School and Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | | |
Collapse
|
19
|
Sterrett S, Morton J, Perry D, Donovan J. Eosinophilic cystitis: successful long-term treatment with montelukast sodium. Urology 2006; 67:423.e19-423.e21. [PMID: 16461108 DOI: 10.1016/j.urology.2005.08.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Revised: 08/03/2005] [Accepted: 08/26/2005] [Indexed: 10/25/2022]
Abstract
We report a rare case of eosinophilic cystitis in a 6-year-old boy who presented with irritative voiding symptoms, peripheral eosinophilia, and a bladder mass initially visualized on ultrasonography. Cystoscopy and transurethral biopsy confirmed the diagnosis. Complete resolution of his symptoms occurred within 1 week of corticosteroid use and the x-ray findings improved within 6 weeks. At 6 months of follow-up, the patient continued to require a leukotriene receptor antagonist (montelukast sodium) despite several attempts to discontinue its use. We propose that eosinophilic cystitis in children who present with peripheral eosinophilia will often require long-term treatment.
Collapse
Affiliation(s)
- S Sterrett
- Department of Urology, University of Nebraska Medical Center, Omaha, Nebraska 68198-2360, USA.
| | | | | | | |
Collapse
|
20
|
Abstract
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.
Collapse
|
21
|
Barese CN, Podestá M, Litvak E, Villa M, Rivas EM. Recurrent eosinophilic cystitis in a child with chronic granulomatous disease. J Pediatr Hematol Oncol 2004; 26:209-12. [PMID: 15125617 DOI: 10.1097/00043426-200403000-00014] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Eosinophilic cystitis is an uncommon disease in children, and its association with chronic granulomatous disease (CGD) has been previously reported in only five patients. In all those patients the disease showed either a self-limited benign course or a rapid response to corticosteroid treatment. The authors describe a child with X-linked CGD who developed eosinophilic cystitis with a recurrent course and difficult therapeutic management. The authors also discuss the pathogenesis of granuloma formation in CGD and review the literature for current therapies for these complications.
Collapse
Affiliation(s)
- Cecilia N Barese
- Division of Immunology, Hospital de Niños "Dr. Ricardo Gutierrez", Associated Hospital to the Universidad de Buenos Aires, Argentina.
| | | | | | | | | |
Collapse
|
22
|
Kiliç S, Erguvan R, Ipek D, Gökçe H, Güneş A, Aydin NE, Baydinç C. Eosinophilic Cystitis. Urol Int 2003; 71:285-9. [PMID: 14512650 DOI: 10.1159/000072680] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2002] [Accepted: 11/06/2002] [Indexed: 11/19/2022]
Abstract
PURPOSE We present a large series of eosinophilic cystitis including 8 cases; 3 of them had tumor-like lesions. MATERIALS AND METHODS The archives of pathology clinic of Inonu University Medical Faculty were reviewed from 1988 to 2002. The characteristics of patients and their diseases were recorded. Data obtained from 180 cases (172 from the literature and 8 from the present series) was assessed. RESULTS Seven cases had symptoms such as dysuria, frequency, hematuria, suprapubic pain, and difficulty in voiding. One asymptomatic case with history of bladder carcinoma was diagnosed during routine cystoscopy. The findings were microhematuria in 6 cases, macrohematuria in 2, pyuria in 3, urinary infection in 1, eosinophilia in 1, hyperazotemia in 1, and bladder masses in 3. Cystoscopies detected edematous and erythematous areas in 5 cases and lesions mimicking bladder carcinoma in 3. One case did not take further treatment after cystoscopy and biopsy and completely recovered. Four cases underwent medical therapy with nonsteroidal anti-inflammatory drugs and antihistaminics. They became asymptomatic and control cystoscopies showed no abnormal finding. Two of three patients with mass lesions recovered after steroid therapy following transurethral resection. The lesion in the third recurred and he improved after a second course of steroid therapy. CONCLUSIONS Eosinophilic cystitis is a rare pathology. Sometimes, it may simulate bladder malignancies. Biopsy is mandatory at diagnosis. Usually, it has a benign course and may be treated with fulguration, analgesics, antihistaminics and steroids, although recurrence is possible.
Collapse
Affiliation(s)
- Süleyman Kiliç
- Department of Urology, Inonu University Medical Faculty, Turgut Ozal Medical Center, Malatya, Turkey.
| | | | | | | | | | | | | |
Collapse
|