Successful Use of Cyclosporine for Eosinophilic Cystitis in a 64-Year Old Female
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Sohaib Aleem, MD, MPH, FACP, Antoine Azar, MD FAAAAI, Bharat Kumar, MD, Mary Beth Fasano, MD FAAAAI, Elizabeth B Takacs, MD
Rationale: Eosinophilic cystitis (EC) is an inflammatory disorder characterized by eosinophilic infiltration of all layers of the urinary bladder wall, muscle necrosis, and fibrosis of the mucosa and muscularis propria. Due to its rarity, there is a lack of consensus regarding treatment. We describe our experience of using cyclosporine in an adult female with biopsy-proven EC.

Methods: ARUP laboratories measured cytokine levels.

Results: A 64-year old female with CKD Stage III, COPD, and hypertension presented with dysuria, urgency, and persistent hematuria for 4 months.  Initial evaluation showed pyuria, hematuria, elevated inflammatory markers and neutrophil-predominant leukocytosis.  There was no peripheral eosinophilia. Bladder wall biopsy showed eosinophil-rich infiltrate. She had elevated IgE (551 IU/ml), CD25 (1351 pg/ml), and Th2 cytokines (IL-4=8, IL-5=7, and IL-13=232 pg/ml). Given the lack of tumor, infection (including parasitic), autoimmune or atopic disease, she was diagnosed with EC. She was prescribed antihistamine, montelukast, high-dose oral and intra-vesical steroids. After two months, her symptoms did not improve, and she developed osteoporosis. Oral cyclosporine (50mg twice daily) was added for steroid-sparing effect and to address the Th2 cytokine profile. The treatment was well-tolerated, enabling further reduction in her maintenance steroid dose. Repeat cystoscopy after 6 months showed no evidence of active EC.

Conclusions: This is the first reported case of EC in an adult with multiple comorbidities in which cyclosporine was used successfully as a steroid-sparing agent and in which serum cytokine levels guided therapy.