Eosinophilic cystitis in children: A case report

Abstract

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.

Eosinophilic cystitis, a rare cause of persistent haematuria in a diabetic dog

“…While the cause of eosinophilic cystitis remains elusive (Sparks et al, 2013), in humans it is believed to result from immune complex deposition in the bladder wall. It has been associated with many other disorders in human beings (He et al, 2018), including recurrent urinary tract infections, atopic diseases, chronic granulomatous disease, medications (oral or intravesical), parasitic infections, bladder neoplasms, interstitial cystitis, and foreign proteins (Runge et al, 2016). In dogs, it is strongly associated with urolithiasis (Evason & Carr, 2007;Walker, 2018), as reported initially in this case.…”

“…The condition has been described in adults, children, and dogs (Abilov et al, 2013;Choi et al, 2017;Evason & Carr, 2007). The most common clinical signs of eosinophilic cystitis reported in the literature include pollakiuria, dysuria, haematuria, suprapubic pain, or urinary retention that mimic other inflammatory conditions (He et al, 2018;van den Ouden, 2000). The disease may also present with a bladder mass mimicking invasive bladder cancer in which case a biopsy is essential for accurate diagnosis (Shih et al, 2012).…”

Eosinophilic cystitis as a rare cause of post-renal acute kidney injury in children: a case report

“…Differential diagnoses included primarily vesical rhabdomyosarcoma, followed by other malignant lesions such as urothelial carcinoma, leiomyosarcoma, lymphoma [3,12,18,20] as well as non-malignant lesions, i.e. solitary fibrous tumor, leiomyoma, or cystitis caused by a polyoma-BK virus and other infectious agents [2,18,25]. Cystoscopy with tissue sampling for histopathological examination or whole layer bladder biopsy is required for the final diagnosis [2,7,13,22,26].…”

Ultrasound-guided co-axial introducer needle biopsy in the diagnosis of eosinophilic cystitis in children

“…Subsequently, there may be a need for long-term monitoring with relevant blood and urine tests and imaging. [ 3 , 4 ] Biopsy is essential for the diagnosis of EC. Currently, cystoscopy with biopsy is recommended by international guidelines.…”

“…Most cases in children are self-limiting and do not require more invasive treatments, but serious complications can occur and relapsing forms have been described. Subsequently, there may be a need for long-term monitoring with relevant blood and urine tests and imaging [3,4] . Biopsy is essential for the diagnosis of EC.…”