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Eosinophilic cystitis mimicking tuberculosis: An analysis of five cases with review of literature.

Kumar S, Sharma V, Ganesamoni R, Singh S - Urol Ann (2013)

Bottom Line: EC should be kept as a differential diagnosis in patients presenting with lower urinary tract symptoms due to small capacity bladder with a negative workup for urinary tuberculosis and in patients having hematuria and negative cytology, or incidentally found bladder lesions with known risk factors.Initial treatment is conservative with removal of risk factor, anti-histaminics and steroids.These patients need a strict and long term follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT
Eosinophilic cystitis (EC) is a rare disease. It is a transmural inflammation of the bladder, predominantly with eosinophils. High index of suspicion is needed for timely intervention. EC should be kept as a differential diagnosis in patients presenting with lower urinary tract symptoms due to small capacity bladder with a negative workup for urinary tuberculosis and in patients having hematuria and negative cytology, or incidentally found bladder lesions with known risk factors. Initial treatment is conservative with removal of risk factor, anti-histaminics and steroids. Augmentation cystoplasty should be considered in patients with a small capacity bladder. These patients need a strict and long term follow-up.

No MeSH data available.


Related in: MedlinePlus

Reconstructed computerised tomography urography image showing small contracted irregular bladder with bilateral hydroureteronephrosis and right percutaneous nephrostomy in situ. White arrows indicate the bilateral vesico-ureteric junction strictures
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Figure 1: Reconstructed computerised tomography urography image showing small contracted irregular bladder with bilateral hydroureteronephrosis and right percutaneous nephrostomy in situ. White arrows indicate the bilateral vesico-ureteric junction strictures

Mentions: Clinical, radiological and pathological data of five patients diagnosed to have EC in our institute from July 2005 to December 2010 were retrieved and analyzed. There were four male patients and one female patient with age ranging from 40 to 80 years. Two of these patients presented with lower urinary tract symptoms and three were incidentally diagnosed but had underlying predisposing factors. The patient demographics, management and clinical outcome are given in Table 1. Our first patient was a 40-year-old male who had history of hematuria and severe frequency of urination for three years. He had been evaluated in an outside hospital. Though acid-fast bacilli smear, culture and Mycobacterium tuberculosis-polymerase chain reaction of urine had been negative, he had been started on anti-tubecular therapy (ATT) empirically based on clinical and radiological parameters. Since he did not have any benefit after completion of ATT, he was referred to our institute. His computerised tomography (CT) urography showed bilateral hydroureteronephrosis with narrowing at bilateral vesico-ureteric junctions with a small capacity bladder [Figure 1]. He underwent supratrigonal cystectomy with ileo-ceco-cystoplasty and bilateral ureteric reimplantation. Intraoperatively, there was a thick walled, small capacity urinary badder with inflamed and friable mucosa. Histopathology revealed eosinophilic cystitis showing transmural dense eosinophilic infiltrate and no evidence of tuberculosis [Figure 2]. At three years follow up, patient was doing well and voiding satisfactorily.


Eosinophilic cystitis mimicking tuberculosis: An analysis of five cases with review of literature.

Kumar S, Sharma V, Ganesamoni R, Singh S - Urol Ann (2013)

Reconstructed computerised tomography urography image showing small contracted irregular bladder with bilateral hydroureteronephrosis and right percutaneous nephrostomy in situ. White arrows indicate the bilateral vesico-ureteric junction strictures
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643326&req=5

Figure 1: Reconstructed computerised tomography urography image showing small contracted irregular bladder with bilateral hydroureteronephrosis and right percutaneous nephrostomy in situ. White arrows indicate the bilateral vesico-ureteric junction strictures
Mentions: Clinical, radiological and pathological data of five patients diagnosed to have EC in our institute from July 2005 to December 2010 were retrieved and analyzed. There were four male patients and one female patient with age ranging from 40 to 80 years. Two of these patients presented with lower urinary tract symptoms and three were incidentally diagnosed but had underlying predisposing factors. The patient demographics, management and clinical outcome are given in Table 1. Our first patient was a 40-year-old male who had history of hematuria and severe frequency of urination for three years. He had been evaluated in an outside hospital. Though acid-fast bacilli smear, culture and Mycobacterium tuberculosis-polymerase chain reaction of urine had been negative, he had been started on anti-tubecular therapy (ATT) empirically based on clinical and radiological parameters. Since he did not have any benefit after completion of ATT, he was referred to our institute. His computerised tomography (CT) urography showed bilateral hydroureteronephrosis with narrowing at bilateral vesico-ureteric junctions with a small capacity bladder [Figure 1]. He underwent supratrigonal cystectomy with ileo-ceco-cystoplasty and bilateral ureteric reimplantation. Intraoperatively, there was a thick walled, small capacity urinary badder with inflamed and friable mucosa. Histopathology revealed eosinophilic cystitis showing transmural dense eosinophilic infiltrate and no evidence of tuberculosis [Figure 2]. At three years follow up, patient was doing well and voiding satisfactorily.

Bottom Line: EC should be kept as a differential diagnosis in patients presenting with lower urinary tract symptoms due to small capacity bladder with a negative workup for urinary tuberculosis and in patients having hematuria and negative cytology, or incidentally found bladder lesions with known risk factors.Initial treatment is conservative with removal of risk factor, anti-histaminics and steroids.These patients need a strict and long term follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT
Eosinophilic cystitis (EC) is a rare disease. It is a transmural inflammation of the bladder, predominantly with eosinophils. High index of suspicion is needed for timely intervention. EC should be kept as a differential diagnosis in patients presenting with lower urinary tract symptoms due to small capacity bladder with a negative workup for urinary tuberculosis and in patients having hematuria and negative cytology, or incidentally found bladder lesions with known risk factors. Initial treatment is conservative with removal of risk factor, anti-histaminics and steroids. Augmentation cystoplasty should be considered in patients with a small capacity bladder. These patients need a strict and long term follow-up.

No MeSH data available.


Related in: MedlinePlus