Clinical Manifestations and Functional Outcomes in Children With Eosinophilic Cystitis

Abstract

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.

How should eosinophilic cystitis be treated in patients with chronic granulomatous disease?

“…WBC white blood cells, E eosinophils, N neutrophils layers of the bladder wall [4]. EC seems to be related to dysregulation of the immune system, as suggested by reports of EC occurring in patients with a history of allergies [5][6][7][8] or subsequent to drug administration (penicillin, mitomycin, clometacin, cyclophosphamide, coumadin, tranilast, and thiotepa) [5,6]. The detection of transmural eosinophilic infiltration should also prompt suspicion of a differential diagnosis, including parasitosis, tumors, tuberculous cystitis, and bladder instrumentation [4,9].…”

“…Is not clear whether the EC in CGD patients depends on the natural course of the immunodeficiency related to hyperinflammation or if it develops in response to other triggers, such as drugs chronically used in these patients. EC usually presents with symptoms of irritative nature, such as dysuria, hematuria, urgency, frequency, and suprapubic tenderness [4,5,7,9]. Patients may also present with an obstructive bladder mass resembling malignancy and causing hydroureteronephrosis [5,10].…”

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

“…The clinical presentation is very diverse, usually associating dysuria, microscopic hematuria and pollakiuria 3,4 . Active urinary tract infection is present in nearly half of the cases 5 at time of diagnosis. Eosinophilic cystitis has been described in very diverse clinical contexts such as post-operative, following a viral or parasitic infection, after intravesical instillation of mitomycin C and during acute kidney stone disease amongst others.…”

“…In cases of persistent ultrasonographic abnormalities under corticosteroid therapy a control cystoscopy should also be performed. Several publications reported unfavorable evolution such as complete bladder fibrosis with reduced compliance requiring aggressive surgical treatments such as bladder augmentation or cystectomy 5,7,12 .…”

“…Immunosuppressive therapies such as cyclosporine have been proposed in exceptional cases of insufficient improvement under corticosteroids 5,11 . Ozdoğan proposes a regular follow-up including clinical examination, ultrasonography and control of initially elevated plasmatic eosinophils count.…”