A rare case of eosinophilic cystitis involving the inside and outside of the urinary bladder associated with an infected urachal cyst

Background Eosinophilic cystitis is a rare inflammatory disease of the bladder characterized by eosinophilic infiltration of the bladder wall. Most Eosinophilic cystitis cases present with mucosal lesions of the urinary bladder. We present a very rare case of large mass-forming eosinophilic cystitis, involving the inside and outside of the bladder associated with an infected urachal cyst. Case presentation A 59-year-old man presented with gross hematuria, fever, dysuria, and suprapubic pain. Computed tomography showed a heterogeneously enhancing mass that measured 7.6 cm × 4 cm located on the anterosuperior portion of the bladder with an internal fluid collection. Cystoscopy revealed a raspberry-like mass lesion on the bladder dome. Transurethral resection of the bladder was initially performed. The mass lesion protruding from inside the bladder was removed, and pus-like fluid was drained. The pathologic diagnosis was eosinophilic cystitis. Follow-up computed tomography showed a remnant mass outside the bladder and urachal cyst. To eliminate the remnant lesion, robot-assisted partial cystectomy was performed. The patient showed no evidence of recurrent disease on follow-up cystoscopy and computed tomography for up to 2 years. Conclusions Clinicians should consider the possibility of eosinophilic cystitis in patients who present with hematuria, fever, and suprapubic pain and have both intravesical and extravesical masses.

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

A cistite eosinofílica é uma doença inflamatória rara caracterizada por infiltração eosinofílica de todas as camadas da parede da bexiga. Essa enfermidade já foi descrita em adultos, crianças e cães. No entanto, não há um consenso de diretrizes sobre o seu tratamento. Mesmo que as literaturas humana e veterinária mostrem alguma eficácia no manejo com corticosteroides, anti-histamínicos e antibióticos, uma variedade de efeitos colaterais graves e frequentes estão associados à terapia com esteróides. Dessa forma, seu uso é relativamente contra-indicado para pacientes com diabetes mellitus e síndrome de Cushing, por exemplo. Um chow-chow, macho, castrado, de cinco anos e diabético estável foi encaminhado para atendimento com histórico de urina fétida, hematúria macroscópica e disúria não responsiva a antibióticos há 18 meses. A avaliação dos parâmetros físicos estava dentro dos padrões, exceto por desconforto abdominal suprapúbico. O hemograma e o perfil bioquímico estavam dentro dos valores de referência, exceto por eosinofilia periférica leve. Embora a ultrassonografia, a radiografia contratada da bexiga e os achados da urinálise indicassem malignidade, a histopatologia confirmou o diagnóstico definitivo de cistite eosinofílica. O manejo com ciclosporina foi satisfatório, com remissão completa da hematúria. Este relato de caso apresenta o primeiro uso documentado de ciclosporina para o tratamento de cistite eosinofílica, com sucesso, em um cão com diabetes.

Pathology of Urinary Bladder in Pearsonema spp. Infected Wildlife from Central Italy

The genus Pearsonema, in the nematode family Capillariidae, includes several species that parasitize the urinary bladders of wild and domestic carnivores. The infection has been reported worldwide from several wildlife species, including canids, mustelids, and felids, but the pathological aspects have seldom been investigated. In order to assess the presence and severity of the lesions in Pearsonema-infected wildlife, we performed a parasitological and pathological examination of urinary bladders from 72 animals, belonging to the families Canidae (red fox Vulpes vulpes, n = 28, and wolf Canis lupus, n = 29) and Mustelidae (beech marten Martes foina, n = 3; pine marten Martes martes, n = 2; and European badger Meles meles, n = 10). A greater prevalence of infection for canids (64.91%; 95% confidence interval (95% CI), 52.52–77.30%) than for mustelids (13.33%) (p < 0.001) was recorded. The prevalence of infection in red foxes was 75.0% (95% CI, 58.96–91.04%), in accordance with other reports from European countries, supporting the role of this species as a reservoir for infection. Eosinophilic cystitis was observed in 34 out of the 72 examined animals (47.22%). The influence of Pearsonema sp. infection on the occurrence of eosinophilic cystitis was statistically significant in wolves (p < 0.01), which were also affected by more severe histological lesions compared to foxes.

Eosinophilic Cystitis Presenting as Possible Pediatric Rhabdomyosarcoma in Conventional Imaging Including 18F-FDG-PET/CT/MRI—A Rare Case

Eosinophilic cystitis (EC) is a relatively rare, but benign inflammatory bladder disease compared to that of the malignant pediatric rhabdomyosarcoma (RMS), in which it can be mimicking on initial suspicion. The origin, symptoms and findings of both EC and RMS are still discussed and hence, lead to the challenge in distinguishing them by cystoscopy and several image modalities. We present a case in which cross-sectional imaging modalities including fluorine-18-fluro-2-deoxy-D-glucose (18F-FDG)-positron emission tomography (PET) / computed tomography (CT) / magnetic resonance imaging (MRI) (18F-FDG-PET/CT/MRI (The imaging modality 18F-FDG-PET/CT/MRI referring to two continuous scans scanned on the same 18F-FDG-tracer dose for both the whole-body 18F-FDG-PET/CT and the regional 18F-FDG-PET/MRI of the pelvis.)) raised suspicion of RMS. Hence, the final diagnosis of EC was established by repeated histopathology. It is important to have EC in mind when seeking differential diagnosis of malignant diseases like RMS in order to provide the correct treatment for the patient and highly homogenously increased 18F-FDG-uptake should raise the suspicion of EC as a differential diagnosis. Furthermore, 18F-FDG-uptake rate is suggested as a future potential biomarker for monitoring of therapeutic response in eosinophilic inflammatory diseases, thus more research on this topic is needed.