Eosinophilic cystitis

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 30 March 2016, last major update April 2011

Copyright: (c) 2003-2016,, Inc.

PubMed Search: Bladder[title] eosinophilic cystitis
Cite this page: Eosinophilic cystitis. website. Accessed October 26th, 2016.
Definition / General
  • Inflammatory condition of the urinary bladder, with recurrent episodes of urinary frequency, dysuria, gross hematuria and suprapubic pain during micturition
  • Not related to Langerhans cell granulomatosis
  • Rare (about 200 reported cases)
  • Women or children with allergic disorders and peripheral eosinophilia, older men with prostate/bladder disorders, or parasitic infestation
Clinical Features
  • Reported at all ages with striking predominance in females
  • 20% occur in children; symptoms tend to disappear spontaneously (Arch Dis Child 2001;84:344)
  • Clinical and imaging findings are nonspecific; cystoscopic findings include ulcers, exudates, edematous bullae or polyps (which may simuate malignancy)
Case Reports
  • Treatments are typically not curative
  • Withdrawal of any identifiable precipitating factor
  • Nonsteroidal anti-inflammatory agents and anti-histamines are favored first-line agents followed by corticosteroids or cyclosporine
  • Transurethral resection is used in refractory cases (J Urol 2001;165:805)
  • Long-term follow-up is recommended for all patients (Int J Clin Pract 2005;59:356)
Clinical Images

Intraoperative photograph shows mass (arrow) protruding into the lumen

Gross Description
  • Edematous and erythematous mucosa with polypoid growths resembling allergic polyps of nasal septum
Micro Description
  • Hispathological findgings can be divided in “acute” and “chronic” phase:
  • Acute phase: prominent eosinophilic infiltrate (Yamada and Taguchi criteria are 20 or more eosinophils per five 20x fields) with edema and occasional muscle necrosis; Charcot-Leyden crystals may be present (Arch Pathol Lab Med 2009;133:289)
  • Chronic phase: fewer eosinophils, but more prominent mast cells, plasma cells and muscle fibrosis
Micro Images

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Eosinophilic cystitis due to schistosomiasis (egg not visible)

Dense inflammatory infiltrate

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Intense infiltration of eosinophils deep within the muscularis propria