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+We present the case of a 70-year-old woman with a history of arterial hypertension, hiatus hernia, constipation and hysterectomy who consulted for irritative voiding syndrome for 8 months, consisting of intense dysuria and pollakiuria with occasional urinary urges without other urological symptoms. In the last 6 months she had presented 3 episodes of lower urinary tract infection with positive urine cultures for E. coli treated by her general practitioner.
+Initial work-up included blood biochemistry which was normal, urine and urine sediment study which showed intense leukocyturia, urine culture which was again positive for E.coli and urine cytology by spontaneous urination which showed urothelial cells without atypia and abundant neutrophilic polymorphonuclear leukocytes. Treatment was prescribed with antibioteparia and anticholinergic (tolterodine).
+After 3 months, the patient was reviewed in the outpatient clinic, with persistent symptoms based on dysuria and pollakiuria, although she had improved considerably from the emergencies with the anticholinergic drug, and even days before the review she had had a new episode of urinary tract infection.
+Given the poor response, a more advanced study was initiated, requesting intravenous urography to rule out a urothelial tumour of the upper urinary tract, which was strictly normal, and urological ultrasound, which was also normal, so cystoscopy was performed in consultation, finding nodular lesions, raised, solid in appearance, slightly reddened, with adjacent areas of oedema, located in the trigone and lower part of both lateral sides. Due to this finding, despite the fact that the patient had no risk factors for TB and the urography was strictly normal, urine smear microscopy and Lowenstein-Jensen culture of 6 samples of the first morning urine on consecutive days were performed, as the bladder lesions macroscopically could be tuberculomas, and these studies were negative for Koch's bacillus, so endoscopic resection of the lesions described was performed under anaesthesia. The anatomopathological study revealed ulceration of the mucosa with significant chronic inflammatory infiltrate and vascular congestion, as well as the presence of plasma cells and lymphocytes constituting lymphoid follicles, These are divided into a central zone with abundant lymphoblasts and immunoblasts, called the clear germinative centre, and a peripheral zone formed by mature cells (lymphocytes and plasma cells) giving rise to mantle lymphocytes or corona radiata, as they are also called.
+
+The patient was prescribed hygienic-dietary measures and long-term antibiotic prophylaxis with a single daily nocturnal dose for 3 months and then every other day for 6 months with ciprofloxacin, vitamin A in a single daily dose for 6 months, prednisone 30mg for 45 days and then every other day for another 45 days until its definitive suspension, and finally digestive protection with omeprazole. The patient experienced clear improvement with progressive disappearance of the symptoms, especially after the third month of treatment.
+Currently (one year after the end of treatment), she is asymptomatic with normal control cystoscopy and negative urine cultures.
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+