PLASMA CELL INFILTRATION OF THE URINARY BLADDER C. S. THAXTON, S. E. EGGENER, AND A. J. SCHAEFFER ABSTRACT We report a novel entity of plasma cell bladder infiltration without other demonstrable disease. The patient had severe irritative voiding symptoms, hematuria, and a diffuse mucosal infiltrate with 90% plasma cells. Although the patient demonstrated some clinical and pathologic evidence consistent with interstitial cystitis and eosinophilic cystitis, a predominant finding of focal plasma cell infiltration of the urinary bladder suggests a new or previously unrecognized clinical entity. UROLOGY 64: 156.e1–156.e2, 2004. © 2004 Elsevier Inc. P lasma cell infiltration of the bladder is a rare occurrence, most commonly observed in inter- stitial cystitis and eosinophilic cystitis. 1,2 We report a patient with severe irritative voiding symptoms, hematuria, and a diffuse mucosal in- flammatory infiltrate consisting primarily of plasma cells. Although the patient demonstrated some clinical and pathologic evidence consistent with interstitial cystitis and eosinophilic cystitis, the predominant finding of focal plasma cell infil- tration of the urinary bladder suggested a new or previously unrecognized clinical entity. CASE REPORT A 68-year-old man presented to another institu- tion with a progressive history of urgency, dysuria, and frequency. He had no history of urologic con- ditions and was otherwise healthy. His prostate was approximately 30 g and smooth, and his postvoid residual urine volume was negligible. Uri- nalysis revealed microscopic hematuria, and urine culture, cytology, and prostate-specific antigen level were normal. Intravenous urography, cystoscopy, and bladder barbotage were normal. Cystometrography re- vealed a bladder capacity of 500 cm 3 without un- inhibited contractions. During the following 18 months, he returned multiple times with worsen- ing irritative symptoms. Multiple cultures, includ- ing expressed prostatic fluid, were acellular. He was empirically treated at different intervals with alpha-antagonists, anticholinergics, anti-inflam- matory agents, antimicrobial agents, and pyr- idium; all failed to improve his symptoms. Ulti- mately, he was treated for interstitial cystitis with dimethyl sulfoxide, antihistamines, tricyclic anti- depressants, bladder distensions, and sodium pen- tosanpolysulfate. None were of clinical benefit. At the time of referral, he was voiding 30 to 40 times per day and passing particulate matter per urethra. His urine and prostatic cultures were nor- mal, as was a computed tomography scan of his abdomen and pelvis. Cystoscopy revealed three flat erythematous areas occupying approximately 10% to 15% of his bladder, with the largest measuring 3 cm. No submucosal glomerulations were present. Urine cytology was normal. Biopsies showed se- vere chronic cystitis with ulcerations in the super- ficial portion of the lamina propria. Approximately 90% of the inflammatory cells present were plasma cells and the remainder were eosinophils and lym- phocytes (Fig. 1). He was treated with prednisone for 1 month. His symptoms improved immedi- ately, with the urinary frequency reduced to eight times daily. At 6 months of follow-up, he was no longer taking steroids and had maintained a similar urinary frequency. However, at 12 months, marked frequency recurred. He began a 6-month course of prednisone, which was associated with a marked improvement in his symptoms. COMMENT The role of plasma cells in normal and inflamma- tory bladder conditions is unknown. Plasma cell From the Department of Urology, Northwestern University Fein- berg School of Medicine, Chicago, Illinois Address for correspondence: Anthony J. Schaeffer, M.D., De- partment of Urology, Northwestern University Feinberg School of Medicine, Tarry 16-703, 303 East Chicago Avenue, Chicago, IL 60611-3008 Submitted: August 4, 2003, accepted (with revisions): March 4, 2004 CASE REPORT © 2004 ELSEVIER INC. 0090-4295/04/$30.00 ALL RIGHTS RESERVED doi:10.1016/j.urology.2004.03.008 156.e1