The patient aged 51 years, women, since she was a teenager had multiple episodes of nonspecific acute cystitis (systematically negative urine cultures and negative urine cultures for BK ) triggered particularly by the exposure to cold, with non response at AINS ( non-steroidal antiinflammatories ) and non-response at treatment with antibiotics but with very good remission to Prednison .
Paraclinical investigations in normal limits
Genital examination combined with ultrasound examination: bilateral ovarian cysts with endometrioma observation or dermoid cyst (clinically present dysmenorrhea with prolonged menstruation and severe menstrual pain that ceased to injectable Piafen (metamizole + pitophenone + fenpipramide).
There was also suspicion of endometriosis because the endometrium had a thickened lining, both ultrasound as well as anatomo-pathology (examination during the total hysterectomy with bilateral anexectomy by the extirpation of the uterine cervix for the bilateral ovarian cysts ). The anatomo-pathologic examination did not show malignant lesions only ovarian cysts benign with thickening walls, some of them being hemorrhagic and thickening endometrial mucosa .
The peculiarity of the case is that urethritis and cystitis seems inflammatory without an infectious context, with remission after Prednison. In general, its onset is at the level of the urethra and after the exposure to cold (therefore, a non specific urethritis), in a patient with a history of chronic urticaria (not in the cold, but sometimes after the exposure to solar radiation) and with history of adverse drug reactions .
There seems to be a connection to the hormonal mood, because the biopsy from the mucosa urinary bladder (a biopsy performed for diagnosis purposes) showed a non specific aspect, with foci of endometrial metaplasia that are interpreted by the anathomo-pathologist as nonspecific, common in cystitis.
Dysmenorrhea has had poor progesterone and estro-progestative improvements, so it is likely that there is a lot of ectopic tissue, not only in the urinary mucosa but probably in the genitals.
The peculiarity of the case is the very good response to Prednison, given that the patient had a history with an episode with acute metroanexitis good response to Prednison .