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

A conservative treatment for eosinophilic cystitis

Introduction

Eosinophilic cystitis is a rare condition which causes common symptoms and may mimic other conditions. Eosinophilic cystitis has several causes such as hypereosinophilic syndrome, inflammatory diseases, neoplasia, parasites or fungal infection, IgE-related diseases, Drug Reaction and Eosinophilia and Systemic Symptoms (DRESS) syndrome, or Churg-Strauss syndrome. Therefore, differential diagnosis is difficult.

Case presentation

We report the case of a middle-aged man affected by eosinophilic cystitis with persistent hematuria and other peculiar symptoms that may be brought back to hypereosinophilic crisis.

Conclusion

Conservative approach is preferred, avoiding radical cystectomy rather than corticosteroid, antihistaminic and second line therapy. Hyperbaric therapy is an innovative approach for severe relapsing gross hematuria without specific literature and should be studied for further indications.

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.

Case: Eosinophilic cystitis presenting as a bladder mass in an 11-year-old girl

We report the case of an 11-year-old girl who presented with acute urinary retention and microscopic hematuria. Pelvic imaging revealed a bladder mass for which sarcoma was initially suspected. Surgical biopsies revealed a massive eosinophilic infiltration of the submucosa confirming a diagnosis of eosinophilic cystitis. Clinical evolution was favourable without treatment. Eosinophilic cystitis prognosis is usually benign, but rare severe complications, such as complete bladder fibrosis requiring bladder augmentation or cystectomy, may occur.

Mass Forming Eosinophilic Cystitis in Pediatric Patients

Eosinophilic cystitis (EC) is an uncommon inflammatory disorder of uncertain etiology that has been described in adult and pediatric populations. We describe 3 recent cases of EC that presented as a mass lesion in pediatric patients from the New England region of the United States. All patients were initially suspected to have a malignancy, and biopsy was performed, which ultimately led to the diagnosis of EC. We propose the use of eosinophil density of >25 eosinophils per high-power field and myocyte degeneration as supportive histopathologic features to make this diagnosis. It is of utmost importance to consider EC in the differential diagnosis when approaching a pediatric patient with a bladder mass.

Macroscopic Hematuria and a Bladder Mass: Eosinophilic Cystitis in a 7-Year-Old Boy

We report a case of eosinophilic cystitis in a 7-year-old boy with a history of atopic symptoms, with focus on the radiological findings. He presented with hematuria and dysuria and ultrasonography (US) showed irregular bladder wall thickening resembling a bladder mass. CT urography did not characterize the lesion any further and showed no local or distant spread. Biopsies revealed eosinophilic cystitis, a benign inflammatory condition. We found that US characterized the lesion at least as well as CT and should be the first choice of imaging. When staging is considered before biopsy, MRI should be preferred to CT. There are no specific radiological signs of eosinophilic cystitis. On follow-up, US was a safe, cost-effective imaging modality, but findings should be interpreted in a clinical context. In a child with hematuria and a bladder mass, eosinophilic cystitis is a relevant but rare differential diagnosis, especially when there is a known atopic history.