嗜酸性膀胱炎合并髂静脉血栓一例报告并文献复习

Eosinophilic cystitis complicated with iliac vein thrombosis:a case report and literatures review

目的:探讨嗜酸性膀胱炎(EC)的临床表现、病理特征和诊治方法及其与深静脉血栓形成间的关联。方法:回顾性分析一例嗜酸性膀胱炎合并髂静脉血栓患者的临床、影像、病理及随访资料。患者,女,54岁,MR提示膀胱右后壁广泛不规则增厚,并呈结节状突向膀胱内,右输尿管扩张,右侧髂外静脉及髂内静脉见条状充盈缺损。总结近10年关于EC的相关文献。结果:膀胱镜见膀胱右侧壁黏膜广泛增厚、水肿、充血,红斑形成并可见团块状隆起。活检提示膀胱黏膜层及黏膜下层广泛嗜酸性粒细胞浸润,符合嗜酸性膀胱炎。予口服抗组胺药、糖皮质激素及利伐沙班治疗3个月,复查MR及膀胱镜提示膀胱壁黏膜光滑,原右髂静脉内血栓消失,双输尿管未见扩张。随访1年未见症状及影像学复发。结论:嗜酸性膀胱炎为少见的膀胱炎性疾病,临床特征有其特异性,并可能通过过敏或炎症介导的高凝和血小板活化诱发深静脉血栓形成,具体机制仍待研究。

ObjectiveTo explore the clinical manifestations,pathological features,diagnosis and treatment of eosinophilic cystitis and its association with deep venous thrombosis(DVT).Methods The clinical,imaging,pathology and follow-up data of an 54-year-old female with eosinophilic cystitis complicated with iliac vein thrombosis were analyzed retrospectively.MR showed uneven thickening of the right posterior wall of the bladder,a nodular soft tissue protruding into the bladder cavity and dilation of the right upper urinary system.A strip flling defect was detected in the right extermal and internal iliac vein.The literatures on EC in recent 10 years were summarized.ResultsCystoscopy showed extensive thickening,edema,congestion,erythema,raised and tumor-like changes of the mucosa on the right wallof the bladder.Bladder biopsies showed a difuse heavy cosinophilic infltrate in the bladder wall,involving the mucosa and submucosa,consistent with eosinophilic cystitis.The patient was treated with a 3-month course of antihistamine,steroid and rivaroxaban.Reexamination of MR and cystoscopy showed that the bladder mucosa was smooth and the original right iliac vein thrombus disappeared.There was no dilatation in the bilateral ureters.No symptom and imaging recurrence were observed in I year of clinical followup.ConclusionEosinophilic cystitis is a rare inflammatory disease of bladder with specific clinical features and may induce DVT through hypercoagulability and platelet activation mediated by allergy or inflammation,but the specific mechanism remains to be investigated.