Eosinophilic cystitis

The cause of eosinophilic cystitis remains unclear, although it has been associated with allergies, reactions to certain medications (antibiotics, chemotherapy), bladder trauma, bladder tumors, and parasitic infections.

Eosinophilic cystitis (EC) is a rare inflammatory bladder condition caused by the build up of eosinophils in the bladder. The exact cause of this condition is not known. However, EC has been found in those with allergies and asthma, and in those with a history of bladder trauma or infection, open bladder surgery, or surgery for a bladder tumor. EC has also been found in those who take certain medications.

Most patients can be cured, but recurrence is a frequent finding. One study examined 118 patients who were treated for eosinophilic cystitis. Of these, 91 patients (77%) were cured, which was defined as the complete absence of symptoms in the short-term and long-term. However, the recurrence of symptoms has been noted in some affected individuals. Thus, those with EC require long-term follow-up with relevant blood tests, urine examination, appropriate imaging, and cystoscopy.

Any possible causative factors, should be avoided or discontinued, such as certain medications (tranilast, mitomycin C). Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, and antihistamines have been used as the primary management of choice with good results. Antibiotics are helpful, especially in those individuals with EC associated with urinary tract infections. Those who do not respond to NSAIDs and antihistamines have been treated with corticosteroids. Corticosteroids and antihistamines are used because they suppress the inflammatory reaction in the bladder. However, symptoms of EC may persist, despite steroid therapy. If symptoms persist after steroid therapy, azathioprine or cyclosporine can be tried. Other treatments include intravesical dimethylsulfoxide, cyclosporin-A (immunosuppressant drug), and silver nitrate.

In those with bladder lesions, surgery has been successful. Few patients with progressive EC not responding to medical therapy or surgery may be considered for more radical procedures, such as partial/total cystectomy (surgical removal of all or part of the bladder).