Oral immunosuppression as a bladder-preserving strategy for cystitis cystica et glandularis with intestinal metaplasia.

Cystitis cystica et glandularis (CCEG) with intestinal metaplasia (IM) is a proliferative condition of the bladder driven from chronic inflammation. Disease ranges from asymptomatic, incidental lesions to end-stage bladder disease with upper tract deterioration. We present the case of a 33-year-old male who presented with a six-year history of pelvic pain and voiding symptoms, found to have a diffusely edematous and inflamed bladder with hydroureteronephrosis requiring nephrostomy placement. Transurethral sampling of abnormal tissue confirmed the diagnosis, and the patient symptomatically and clinically improved on oral immunosuppression. This case demonstrates the spectrum of presentation of intestinal type-CCEG and management strategies.