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New Emirates Medical Journal

Editor-in-Chief
ISSN (Online): 0250-6882

Case Report

A Case of Eosinophilic Cystitis treated with Mepolizumab

Author(s): Saeed Alzaabi and Mohsen Nasir*

Volume 4, Issue 1, 2023

Published on: 15 May, 2023

Article ID: e130323214558 Pages: 3

DOI: 10.2174/04666230313100005

open_access

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Abstract

Background: Eosinophilic cystitis is a rare inflammatory cystitis of unknown origin. Common symptoms include urinary frequency, urgency, pain, and recurrent urinary tract infections. Currently used treatments include corticosteroids, anti-inflammatory drugs, antihistamines, and antibiotics. Here we present a case of successful treatment of eosinophilic cystitis with mepolizumab.

Case Presentation: A 41-year-old female presented with urinary frequency, urgency, and suprapubic pain. She underwent multiple tests including cystoscopy and biopsy, which revealed a diagnosis of eosinophilic cystitis in 2000. She was initially managed with oral antihistamines and oral steroids. However, over the years her symptoms increased in frequency, intensity, and duration. Montelukast 10 mg daily started which did not show any improvement. In 2017 Mepolizumab 100 mg every 4 weeks started. The patient noted improvement after a few months, and she was tolerating her injections well without side effects and had no further flares of her condition.

Discussion: We present a case of eosinophilic cystitis which was refractory to multiple treatments and responded well to mepolizumab. There are no definite guidelines for the management of EC and there is no curative treatment for this disease. Mepolizumab is an anti-IL-5 monoclonal antibody and the use of mepolizumab in the management of EC that is refractory to treatment have been reported in a few cases. The use of mepolizumab has been described in different diseases associated with eosinophilic inflammation such as severe eosinophilic asthma, eosinophilic esophagitis, eosinophilic chronic obstructive pulmonary disease, and severe nasal polyposis.

Conclusion: Mepolizumab can be considered a treatment option in EC cases refractory to the standard treatment. At this time, larger studies are needed to evaluate the efficacy and safety of mepolizumab in EC.

Keywords: Eosinophilic, Cystitis, Biologics, Mepolizumab, Monoclonal antibody, Cystoscopy.

[1]
Brown EW. Eosinophilic granuloma of the bladder. J Urol 1960; 83(5): 665-8.
[http://dx.doi.org/10.1016/S0022-5347(17)65773-2] [PMID: 13804922]
[2]
van den Ouden D. Diagnosis and management of eosinophilic cystitis: A pooled analysis of 135 cases. Eur Urol 2000; 37(4): 386-94.
[http://dx.doi.org/10.1159/000020183] [PMID: 10765067]
[3]
Mosholt KSS, Dahl C, Azawi NH. Eosinophilic cystitis: Three cases, and a review over 10 years. BMJ Case Rep 2014; 2014: bcr2014205708.
[http://dx.doi.org/10.1136/bcr-2014-205708]
[4]
Teegavarapu P, Sahai A, Chandra A, Dasgupta P, Khan M. Eosinophilic cystitis and its management. Int J Clin Pract 2005; 59(3): 356-60.
[http://dx.doi.org/10.1111/j.1742-1241.2004.00421.x] [PMID: 15857336]
[5]
Zaman SR, Vermeulen TL, Parry J. Eosinophilic cystitis: Treatment with intravesical steroids and oral antihistamines. BMJ Case Rep 2013; 2013: bcr2013009327.
[http://dx.doi.org/10.1136/bcr-2013-009327]
[6]
Aleem S, Azar A, Kumar B, Fasano MB, Takacs EB. Successful use of cyclosporine for eosinophilic cystitis in a 64-year old female. J Allergy Clin Immunol 2016; 137(2): AB166-6.
[http://dx.doi.org/10.1016/j.jaci.2015.12.676]
[7]
Nucala (mepolizumab) for injection. Research Triangle Park, NC: GlaxoSmithKline 2015.
[8]
Cooke WD, Cooke AT. Eosinophilic cystitis treatment with benralizumab. J Allergy Clin Immunol 2020; 145(2): AB67.
[http://dx.doi.org/10.1016/j.jaci.2019.12.734] [PMID: 33102077]
[9]
Dixit C, Bullock T, Kahle L, Warrier M. Use of benralizumab in refractory eosinophilic cystitis improves symptoms and reduces bladder eosinophils. J Allergy Clin Immunol 2021; 147(2): AB64-4.
[http://dx.doi.org/10.1016/j.jaci.2020.12.254]
[10]
Pavord ID, Korn S, Howarth P, et al. Mepolizumab for severe eosinophilic asthma (DREAM): A multicentre, double-blind, placebo-controlled trial. Lancet 2012; 380(9842): 651-9.
[http://dx.doi.org/10.1016/S0140-6736(12)60988-X] [PMID: 22901886]
[11]
Ortega HG, Liu MC, Pavord ID, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med 2014; 371(13): 1198-207.
[http://dx.doi.org/10.1056/NEJMoa1403290] [PMID: 25199059]
[12]
Stein M, Collins M, Villanueva J, et al. Anti–IL-5 (mepolizumab) therapy for eosinophilic esophagitis. J Allergy Clin Immunol 2006; 118(6): 1312-9.
[http://dx.doi.org/10.1016/j.jaci.2006.09.007] [PMID: 17157662]
[13]
Pavord ID, Chanez P, Criner GJ, et al. Mepolizumab for eosinophilic chronic obstructive pulmonary disease. N Engl J Med 2017; 377(17): 1613-29.
[http://dx.doi.org/10.1056/NEJMoa1708208] [PMID: 28893134]
[14]
Gevaert P, Van Bruaene N, Cattaert T, et al. Mepolizumab, a humanized anti–IL-5 mAb, as a treatment option for severe nasal polyposis. J Allergy Clin Immunol 2011; 128(5): 989-995.e8, 8.
[http://dx.doi.org/10.1016/j.jaci.2011.07.056] [PMID: 21958585]

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