Eosinophilic cystitis in children:a report of 7 cases and literature review / 临床儿科杂志

Objective To explore the clinical and pathological features, diagnosis and treatment of eosinophilic cystitis in children. Method The clinical data of 7 patients with eosinophilic cystitis admitted from 2012 to 2016 were retrospectively analyzed, and the related literature were reviewed. Results The median age of the 7 patients was 9 years, and clinical manifestations were urgent urination, frequent micturition, odynuria, hematuria, abdominal pain and nocturnal enuresis. Ultrasonography and CT examination showed thickened bladder wall and space occupying lesions.All the 7 children received bladder biopsy, and pathology was consistent with eosinophilic cystitis. Six of them were cured after 2 months of drug therapy, and the other one was cured by repeated drug treatment for 1 year.All patients were followed up for 3 months to 4 years until the abnormal symptoms of voiding disappeared and the abnormal changes of bladder disappeared by imaging examination. Conclusion Eosinophilic cystitis in children is a benign lesion, having extremely similar clinical manifestations to bladder tumor. Without biopsy, the diagnosis of eosinophilic cystitis can also be made according to the clinical manifestation, laboratory examination and treatment effect. The treatment for this disease mainly includes hormone, antihistamine and anti-inflammatory drugs.

Eosinophilic cystitis mimicking muscle-invasive bladder cancer: a case report and literature review / 中华泌尿外科杂志

Objective To evaluate the clinical and pathological features of eosinophilic cystitis (EC),and to discuss its diagnosis and treatment.Methods The clinical and pathological data of one case of eosinophilic cystitis were reported.An 86-year-old male with gross hematuria and urinary urgency for 15 days was admitted on 16 March 2015.A computed tomography scan showed uneven thickening of the bladder wall and a nodular soft tissue on the anterior wall protruding into the bladder cavity.Results Cystoscopic examination showed diffuse thickening of the bladder with polypoid red lesions on the anterior wall.Transurethral biopsies revealed infiltrating eosinophils,which was consistent with the diagnosis of EC.The patient was then treated with anti-inflammatory drugs,corticosteroids and anti-histamine drugs.At 6 months of follow-up,the patient was asymptomatic and had no evidence of local recurrence by ultrasonography.Conclusions Eosinophilic cystitis is a rare disease without specific clinical and imaging features,which can mimic bladder tumor.The final diagnosis of this disease depends on the pathology.Transurethral resection of the lesion along with postoperative hormone and antihistamines administration are the main choices of treatment.

Hypereosinophilic Syndrome Presenting as Eosinophilic Cholangiopathy and Cystitis / 대한췌담도학회지

Eosinophilic cholangiopathy is a rare disease characterized by dense transmural eosinophilic infiltration of the gallbladder and bile duct. It's clinical and laboratory manifestations are not different from those of other causes of cholangiopathy, and the diagnosis is usually made based on pathologic findings after cholecystectomy. Moreover, the occurrence of eosinophilic cystitis accompanied by cholangiopathy is extremely rare. We report a rare case of hypereosinophilic syndrome manifested as eosinophilic cholangiopathy accompanied with eosinophilic cystitis, for the first time in Korea, in a 49-year-old woman who presented with persistent right upper quadrant pain. After performing imaging study to validate the diagnosis of acute acalculous cholecystitis and cholangitis, an urgent cholecystectomy was performed. Pathologic examination of the excised gallbladder was consistent with eosinophilic cholecystitis. The patient underwent bladder biopsy because there was persistant irritative voiding symptoms combined with constant mild peripheral eosinophilia even after cholecystectomy, and the pathologic findings revealed eosinophilic cystitis. Symptoms and peripheral eosinophilia were improved after steroid therapy for an indicated period.

A Case of Hypereosinophilic Syndrome with Bladder Involvement in a 7-Year-Old Boy

Hypereosinophilic syndrome (HES) is characterized by the presense of hypereosinophilia with evidence of target organ damage. We report a patient diagnosed with eosinophilic cystitis and HES. A 7 year old boy had hematuria, dysuria, and increased urinary frequency for 1 day. Laboratory examinations revealed hypereosinophilia (eosinophils, 2,058/microL), hematuria, and proteinuria. Abdominal sonography revealed diffuse and severe wall thickening of the bladder. The patient was treated initially with antibiotics. However, his symptoms did not improve after 7 days. A computed tomography scan demonstrated severe wall thickening of the bladder and the hypereosinophilia persisted (eosinophils, 2,985/microL). The patient complained of chest discomfort, dyspnea, epigastric pain, and vomiting on hospital day 10. Parasitic, allergic, malignancy, rheumatologic, and immune workups revealed no abnormal findings. Chest X-rays, electrocardiography, and a pulmonary function test were normal; however, the hypereosinophilia was aggravated (eosinophils, 3,934/microL). Oral deflazacort was administered. A cystoscopic biopsy showed chronic inflammation with eosinophilic infiltration. The patient's respiratory, gastrointestinal, and urinary symptoms improved after 6 days of steroids, and he was discharged. The eosinophil count decreased dramatically (182/microL). The hypereosinophilia waxed and waned for 7 months, and the oral steroids were tapered and stopped. This case describes a patient diagnosed with eosinophilic cystitis and HES.

Ultrasonic diagnosis and clinical analysis of eosinophilic cystitis in children / 中华实用儿科临床杂志

Objective To explore the ultrasound imaging and the clinical analysis of eosinophilic cystitis in children and to improve the understanding of this very rare clinical disease.Methods The ultrasound imaging of 9 patients who were diagnosed as eosinophilic cystitis in Nanjing Children's Hospital Affiliated to Nanjing Medical University from Jul.2007 to May 2013 were analyzed retrospectively,and the relevant literatures were reviewed.Results The ultrasound imaging of the 9 patients were described as follows:4 cases showed a diffuse thickening bladder wall,2 cases showed a localized mass-like thickening bladder wall,and 3 cases showed a markedly thickening anterior bladder wall and bilateral bladder wall.Laboratory studies showed that all the patients were presented with eosinophilia.Six patients underwent cystoscopy that showed an erythematous,and velvety appearance of the bladder mucosa.Histopathology disclosed a bladder mucosal tissue with dense interstitial eosinophilic infiltration consistent with eosinophilic cystitis.Three patients had clinical resolution under the treatment of anti-infections and urine alkalinization.Other 6 patients received prednisone at 0.5-1.0 mg/kg and an antihistamine treatment.Prednisone was eventually tapered off after 2-week reemission.Regular follow-up by urinary bladder ultrasound and urine routine did not show any disease recurrence in 9 children.Conclusions The combination of bladder wall thickening and peripheral eosinophilia may suggest the likely diagnosis of eosinophilic cystitis.Cystoscopy with bladder biopsy is the most important step in the diagnosis of eosinophilic cystitis.Anti-histamines and corticosteroids can be used as the primary management and have good results.

Progress in diagnosis and treatment of eosinophilic cystitis in children / 中华实用儿科临床杂志

Eosinophilic cystitis(EC) is a kind of bladder proliferation disease and rather rare in children.The pathological character shows invasion of huge amounts of eosinophil granulocytes in the total bladder wall.Although it has unknown etiology,but it is widely believed to be involved in allergy.It can appear at any age with a higher incidence in male.Since it was first reported in 1960,there are a total of more than 300 patients reported,about 70 of them are children.The major clinical manifestations are urinary frequency,suprapubic pain during miction,gross or microscopic hematuria,dysuria,nocturia and so forth.Some patients with increased eosinophils in the peripheral blood.It is essential to examine blood routine,urine routine,imaging tests and cystoscopy and defining diagnosis depends on histopathologic biopsy.The self-limiting of EC in children is much stronger.The main therapies for EC are application of corticosteroids,antihistamines and so forth,while feasible operation should be treated when severe complications appear or the disease progress.

Diagnosis and treatment of eosinophilic cystitis in children / 中华实用儿科临床杂志

Objective To explore the diagnosis and treatment of eosinophilic cystitis (EC) in children.Methods Six patients who experienced EC in Nanjing Children's Hospital Affiliated to Nanjing Medical University from Mar.2007 to Feb.2012 were analyzed and the relevant literature was reviewed.This group included 5 male and 1 female,with mean age of 5.3 years.Their major complains included urinary frequency in 5 cases,odynuria in 3 cases,dysuria in 2 cases,hematuria in 2 cases,proteinuria in 2 cases,urinary dribbling in 1 case,and nocturia in 1 case.Physical examination and urine culture was positive in 1 case,eosinophil proportion of peripheral blood increased in 3 cases,imaging studies suggested the bladder wall thickening in 5 cases and space-occupying lesions in 2 cases.Cystoscopy in 4 cases and biopsy in 3 cases showed EC.Results Three patients were cured after receiving anti-infection and urine alkalinization,and another 3 patients were cured after adding Prednisone and Ketotifen,or Oxybutynin or Loratadine.Five patients were followed up for 1-60 months,and clinical symptoms,blood,urine,and B-ultrasound in these patients were normal.The information of 1 case was lost.Conclusions The incidence of EC in children tends to increase in recent years,the diagnosis can be confirmed combined with the clinical manifestations,laboratory tests,imaging studies and histological examination.Conservative treatment is preferred.

Cistitis eosinofílica: ruptura vesical espontánea recurrente en un adulto / Eosinophilic cystitis: recurrent spontaneous bladder rupture in an adult

Introducción: La cistitis eosinofílica descrita por primera vez en 1960 por Brown, corresponde a una patología inflamatoria de la vejiga muy infrecuente, de etiología específica aún incierta. Puede variar desde inflamación moderada, hasta vejiga fibrótica con dilatación pielocalicilar y grados variables de insuficiencia renal. Si bien, tiene una presentación clínica variable, no se ha descrito previamente en la literatura la perforación vesical espontánea recurrente. Caso clínico: Presentamos el caso de una mujer de 35años con historia de hematuria, poliquiuria, tres perforaciones vesicales espontáneas y microvejiga fibrótica con hidroureteronefrosis bilateral que se maneja finalmente con ampliación vesical con segmento de íleon y además, exponemos una revisión actualizada de la literatura. Conclusión: La cistitis eosinofílica es una entidad de etiología incierta, con una historia natural impredecible. Su incidencia y prevalencia son desconocidas y si bien, no ha sido descrita previamente en un adulto en nuestro medio, es recomendable considerarla entre los diagnósticos diferenciales de una hematuria macroscópica o síndrome de irritación vesical persistente. La ruptura vesical espontánea recurrente es una presentación clínica no descrita previamente en la literatura. Se deben continuar periódicamente controles imagenológicos y de laboratorio y su tratamiento aún no está estandarizado.

Introduction: Eosinophilic cystitis was first described in 1960 by Brown, it is an inflammatory disease of the bladder that is extremely rare where etiology remains uncertain. It ranges from a mild inflammation to a fibrotic bladder with pielocalycilar dilatation and varying degrees of renal failure. While it has a variable clinical presentation, recurrent spontaneous bladder perforation has not been described previously in the literature. Case report: We report the case of a 35 years old women with a history of hematuria, polyaquiuria, three spontaneous bladder perforations and fibrotic microbladder with bilateral hydroureteronephrosis that is finally managed by bladder augmentation made of an ileum segment. Additionally, we present an updated revision of the literature. Conclusion: Eosinophilic cystitis is an entity of unknown etiology with an unpredictable evolution. Incidence and prevalence are unknown and although it has not been previously reported in our adult patients, it should be considered as differential diagnosis of gross hematuria or persistent bladder irritation syndrome. Recurrent spontaneous bladder rupture is a clinical presentation not previously described in the literature. Periodic monitoring and laboratory imaging should be established and treatment is not yet standardized.

A Case of Eosinophilic Cystitis in a Patient with Diabetes Mellitus / 대한신장학회잡지

Eosinophilic cystitis is an uncommon disease which is characterized by eosinophilic infiltration into all layers of bladder. It was first described in 1959 by Brown and 50 cases have been reported in the literature. The presenting symptoms are frequency, urgency, dysuria and hematuria. It is chronic disease with remission and exacerbation and mimics other forms of chronic cystitis, such as interstitial cystitis, tuberculosis and bladder neoplasm. Diagnosis is made by biopsy. Treatment consists of removal of inciting allergens, corticosteroids, antihistamines, and antibiotics for secondary bacterial infection. Most women and children with eosinophilic cystitis had the history of allergic disease or asthma and most male patients had bladder or prostatic disorders, such as benign prostatic hypertrophy, bladder carcinoma, and congenital anomalies. But eosinophilic cystitis has not been found in diabetic patients yet. We report a case of eosinophilic cystitis in a 59- year-old diabetic patient with brief review of the literature.

A Case of Eosinophilic Cystitis presenting as Invasive Bladder Cancer / 대한비뇨기과학회지

Eosinophilic cystitis is characterized by an eosinophilic infiltration usually of all layers of the bladder wall, ranges from a mild form of cystitis to a chronic recurrent relentless inflammation which even may progress to the point of damaging the upper urinary tracts with deterioration of the renal function. The etiology remains unclear, and there is no specific therapy available. The tumoral form of eosinophilic cystitis is a rare phenomenon and characterized by an extensive bladder wall infiltration, that may clinically imitate an invasive bladder cancer. We report a case of eosinophilic cystitis appeared to be an invasive bladder cancer extending to the pelvic side wall in a 37-year-old female, who was treated with transurethral resection.

Eosinophilic Cystitis / 대한비뇨기과학회지

Eosinophilic cystitis is a rare inflammatory disease of urinary bladder with unknown etiology. The disease is known to be associated with several different processes such as allergy or injury. Eosinophilic cystitis is similar to interstitial cystitis, vesical tuberculosis and bladder neoplasm in clinical manifestations and should be differentiated from them. A 75 years old male patient underwent TUR-P for benign prostatic hyperplasia. After 2 months, he complained of irritative voiding symptoms. Cystoscopy revealed a polypoid mass, measuring 3 cm in diameter in the right lateral wall of bladder. Pathology of the lesion that was transurethrally resected revealed the diffuse eosinophilic infiltration of the bladder wall without evidence of malignancy.

Eosinophilic cystitis / 대한비뇨기과학회지

Eosinophilic cystitis is a rare inflammatory condition whose etiology remains poorly understood. Eosinophilic cystitis is characterized histologically by infiltration of eosinophils into all layers of the bladder.We herein report two cases of eosinophilic cystitis with brief review of the literiture.

A case of eosinophilic cystitis / 대한비뇨기과학회지

Eosinophilic cystitis is an uncommon inflammatory process seen in children and adult which was recognized in 1960. The disease is similar to interstitial cystitis. tuberculosis and bladder neoplasms in the clinical manifestations and should be differentiated from them. We herein report a case of eosinophilic cystitis in a 60-year-old woman which was confused. with bladder carcinoma with brief review of the literatures.

A Case of Eosinophilic Cystitis / 대한비뇨기과학회지

Eosinophilic cystitis is a rare inflammatory disease of bladder with unknown etiology. The disease is known to be associated with several different processes such as allergy or injury. Eosinophilic cystitis is similar to interstitial cystitis, tuberculosis and bladder neoplasms in the clinical manifestations and should be differentiated from them. A 42-year-old male patient presented with gross hematuria, frequency and dysuria. Urinalysis showed hematopyuria. Cystoscopy revealed a hemorrhagic and necrotic polypoid mass, measuring 3cm in diameter on the dome of the bladder. Pathology of the lesion revealed the diffuse eosinophilic infiltration of the bladder wall without evidence of malignancy. The patient was treated with a 2-month course of 10mg prednisolone 3 times a day. The symptoms improved. After 3 months, followup cystoscopy and cystography showed normal findings.

Eosinophilic Cystitis / 대한비뇨기과학회지

Since Brown first described the eosinophilic cystitis in 1959, 42 cases has been reported in the literature. In Korea, only 1 case was reported from the National Medical Center a couple of years ago. Eosinophilic cystitis is characterized histologically by infiltration of eosinophils into the mucosa, submucosa and muscularis of the bladder and cystoscopically by elevated erythematous mucosal lesions. These lesions have been mistakenly diagnosed as bladder tumors prior to biopsy. Clinically, it presents with dramatic and recurrent episodes of dysuria and hematuria. It can occur in two different clinical setups. The first is seen in women and children and is often associated with allergic disorders and eosinophilia. The second presents in older man and is usually associated with bladder injury related to other conditions of bladder and prostate. We herein add two cases of eosinophilic cystitis, review etiologic theories and outline management.

Eosinophilic Cystitis / 대한비뇨기과학회지

Eosinophilic cystitis is a baffling rarity impossible to distinguish grossly from bladder tumor. It is characterized by vesical irritability, hematuria and eosinophilia. The etiology is unknown. Authors have found only 7 cases in the literature and present one case which was mimicking papillary carcinoma. Patient 35 years-old married man, was admitted to Seoul National University Hospital on March 13. 1967. with a one-week history of hematuria, urgency, frequency and dysuria. Physical examination was negative. Hemograms showed normal except eosinophilia of 10% to 16%. Urinalysis showed one plus proteinuria, many red cells and 5 to 6 white cells per high power field. An excretory urogram displayed essentially normal. At cystoscopy marked bullous edema on entire bladder wall and large polypoid lesion in anterior wall were noted. Punch biopsy was done and it revealed mild degree transitional cell carcinoma of the bladder. He underwent bilateral cutaneoureteroetomy and cystectomy. The surgical specimen, however, showed no malignant lesion but diffuse eosinophilic cystitis.