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.