Eosinophilic Cystitis

In recent years, a number of reports on eosinophilic infiltration of the stomach and/or upper intestinal tract have been published. To the author's knowledge, however, no instances of such involvement of the urinary tract have been recorded in the English literature. The purpose of this paper is to describe the clinical history and principal roentgenographic findings in a patient with eosinophilic infiltration of the urinary bladder. Case Report G. E., a 31-year-old Caucasian housewife, was admitted to the University of California Medical Center for the second time on Aug. 12, 1959, because of swelling of the abdomen for one week. One year previously, she had been in the hospital for investigation of recurrent crampy abdominal pain associated with back pain, diarrhea changing to constipation, anorexia, weight gain, and swelling of the abdomen, all of six weeks duration. She stated that she was allergic to weeds and grass, which gave her rhinitis, and a family history of asthma was obtained (grandmother). Findings at the time of the first admission, pertinent to the present report, included ascites, a tender, palpable mass on the right side on pelvic examination, and a persistent eosinophilia up to 36 per cent. The urinary bladder appeared normal on intravenous urography. Roentgenographic examination showed a normal stomach, and the appearance of the small bowel was consistent with regional enteritis. On exploratory laparotomy, the entire small bowel was found to be thickened and covered with a fibrinous exudate. A segment of the ileum removed for microscopic examination showed dense infiltration of the bowel wall with eosinophils and perivascular round-cell infiltration. The pathologic diagnosis was eosinophilic enteritis. Prednisone therapy was instituted and, after an uneventful postoperative convalescence, the patient was discharged under the continuing care of her physician. She remained relatively well thereafter until the onset of symptoms which led to her second hospital admission. Prednisone was discontinued in April 1959, and two months later an episode of “asthma” occurred, with wheezing. A month after this episode severe dysuria developed, with frequency, polyuria, nocturia, and incontinence. These symptoms were somewhat relieved by medication prescribed by her physician. In the week prior to her second hospital admission, Aug. 12, 1959, periumbilical abdominal pain and abdominal swelling, such as had been observed the previous year, recurred. The pertinent findings on examination on this second admission were a moderately protuberant abdomen, diffuse abdominal tenderness and rebound tenderness, an abdominal fluid wave, and symmetrical 1 + ankle edema.