CALL US

Tel: +39.0523.315144 | Fax: +39.0523.1860018

EMAIL US
OPENING HOURS

Mon - Fri: 10 am - 4 pm

Disclaimer
ESSIC endeavours to ensure that all information it provides is correct and accurate, but does not accept any liability for errors or inaccuracies.

ESSIC does not necessarily endorse any commercial products mentioned on its website or in any other information material it publishes.

© 2018 by ESSIC

Confusable versus associated diseases

 

The words "confusable disease" and "associated disease" are always used in connection with another disease, in our situation in connection with BPS.

For BPS, a confusable disease is a disease which may show similar symptoms and/or signs to those of BPS. In general, such a confusable disease needs to be excluded as the main cause of the symptoms and/or signs before a diagnosis of BPS can be made. In practice, the situation may be more complex as the presence of a confusable disease does not necessarily exclude the presence of BPS as well. If both a confusable disease and BPS are present, it is clear that for individual diagnoses of patients and for epidemiological studies, the presence of a confusable disease should not exclude a diagnosis of BPS. For many scientific studies, on the other hand, e.g. for studies on the effect of a particular treatment, only patients with BPS without an additional confusable disease should be accepted as the confusable disease may severely interfere with outcome parameters of such a study.

BPS has several associated diseases. Associated diseases are diseases with a higher prevalence among patients with BPS than in the general population. This does not necessarily imply a causal relationship between BPS and the associated disease. The practical consequence of associated diseases is that medical professionals should know these associations and should have a high index of suspicion for the associated diseases.

 

General aspects of confusable diseases

 

Confusable diseases misdiagnosed as interstitial cystitis

Vasculitis

  • A 73-year-old woman with chronic pelvic pain, burning toes, and an eighty-pound weight loss.
    Birnbaum J, Chai TC, Ali TZ, Polydefkis M, Stone JH. Arthritis Rheum 2008;59:1825-31. 
    • an elderly woman is described with a 5-year history of chronic bladder and pelvic pain, an 80-pound weight loss, a small fiber neuropathy, and interstitial lung disease
    • laboratory tests showed a strongly positive rheumatoid factor, and positive ANCA assays associated with perinuclear immunofluorescence and antigen specificity for myeloperoxidase.
    • bladder biopsies containing bladder mucosa showed no specific abnormalities
    • a (false) diagnosis of IC/PBS was made; only after a cystectomy was performed, a necrotizing vasculitis of medium-sized arteries was seen that led to the right diagnosis of microscopic polyangiitis (MPA); disease remission was obtained after adequate treatment for MPA
    • it is likely that if deeper bladder biopsies would have been done containing detrusor muscle at initial evaluation, the correct diagnosis could have been made 5 years earlier; moreover, the patient would also have received adequate treatment for a potentially fatal disease 5 years earlier and a cystectomy wouldn't have been necessary

 

Tuberculosis

  • Dysuria and a headache
    Lo S, Noble J, Bowler I, Angus B. Lancet 2004;364:1554
    • a case report of a 49-year-old white woman with symptoms of recurrent urinary tract infections; she had no other medical history of note and she had not traveled outside of the UK 
    • an initial diagnosis of interstitial cystitis was found to be wrong; despite she had no pulmonary disease, the cystitis was found to be due to infection withMycobacterium tuberculosis 

 

Malignancies

  • A referral center’s experience with transitional cell carcinoma misdiagnosed as interstitial cystitis.
    Tissot WD, Diokno AC, Peters KM. J Urol 2004;172:478-80
    • a retrospective review of patient records showed that between 1998 and 2002 a total of 600 patients were seen with the diagnosis of interstitial cystitis (IC) 
    • six patients (1%) previously diagnosed as having IC were found to have transitional cell carcinoma as the cause of symptoms, 4 of whom (67%) had no hematuria
    • the authors conclude that patients with irritative voiding symptoms require a thorough evaluation which may include cystoscopy, cytology and upper tract imaging; they expect that the number of wrong diagnoses of IC would increase if the criteria to diagnose IC and initiate treatment were oversimplified

 

Drug-induced cystitis

  • Eosinophilic cystitis induced by penicillin
    Tsakiri A, Balslev I, Klarskov P. Int Urol Nephrol 2004;36:159-61
    • a 30-year-old woman developed classic symptoms of painful bladder disease and eosinophilic cystitis as an adverse effect of penicillin for abdominal actinomycosis; the symptoms were reversible after stopping penicillin

 

Various

 

Lupus Cystitis

General information on systemic lupus erythematosus

  • Systemic lupus erythematosus
    Rahman A, Isenberg DA. N Engl J Med 2008;358:929-39
    • a great review on genetic and epidemiologic factors, autoantibodies, tissue damage by autoantibodies, the role of T cells, source of the autoantigens, cytokines and implications for treatment

 

Relationship between BPS and SLE

  • Interstitial cystitis and systemic lupus erythematosus in a 20-year old woman.
    do Socorro Teixeira Moreira Almeida M, Carvalho LL, Carvalho AG, et al. J Rheumatol Int 2008 Aug 12. (Epub ahead of print] PMID: 18696074
    • a case report of a 20-year-old woman with systemic lupus erythematosus; she presented with dysuria, urinary frequency and suprapubic pain and was found to have a interstitial cystitis

  • Lupus cystitis on Ga-67 scans
    Lin WY, Lan JL, Wang SJ. Clin Nucl Med 2000;25:737
    • a 46-year-old woman with systemic lupus erythematosus had hematuria, fever, and proteinuria. She was transferred to the nuclear medicine department for evaluation of the disease activity of lupus nephritis. A Ga-67 scan showed increased radioactivity in both kidneys. Active nephritis was suggested. Furthermore, increased Ga-67 uptake in the wall of the urinary bladder was also noted. Lupus cystitis was indicated. A bladder biopsy confirmed the diagnosis.

  • Involvement of the urinary bladder in systemic lupus erythematosus. A pathologic study.
    Alarcon-Segovia D, Abud-Mendoza C, Reyes-Gutierrez E, et al. J Rheumatol 1984;11:208-10 
    • urinary bladder histologic changes were found in 16 of 35 necropsies from systemic lupus erythematosus (SLE) patients; these included interstitial cystitis (n = 11), hemorrhage (n = 9), congestion (n = 7), vasculitis (n = 5), and perivenular infiltrate (n = 4)

  • Similarity of interstitial cystitis to lupus erythematosus. 
    Fister GM. J Urol 1938;40:37-51

   Other bladder conditions  

  • Incomplete bladder emptying (retention)

   Gynaecological conditions  

  • Vaginal candidiasis

 

   Male diseases  

 

  Various  

CONFUSABLE DISEASES