全尿路アレルギーの1例

Abstract

A 20-year-old man had a sudden attack of fever and general malaise, and was treated as cold. He then developed flank pain on the right side and gross hematuria associated with frequent urination, burning and dysuria. His past history showed urticaria of several occasions. He was admitted to the urological ward. Laboratory examinations showed blood sedimentation rate 14 mm in average, no anemia, no abnormalities in blood coagulation, normal value of total serum protein and its fractions, normal liver and renal functions. Immunological tests of the serum were also normal. Urological examinations revealed the palpable and tender kidney on the right side and the bladder region sensitive on pressure. The external urethral meatus was reddened and swollen with mucous discharge. Urinalysis showed hematopyuria and presence of small amount of bacteria. Cystoscopy revealed bladder capacity 150cc, marked bullous edema of the entire mucosa and hematuria from the both ureteral orifices. Excretory pyelography showed no stone, delay of dye excretion from the right kidney, and notching in the right pyeloureterogram and left ureterogram. Cystogram also showed scalloping. From the above findings, it was thought that the patient had edematous change of the entire urinary tract mucosa due to allergic reaction. He was then placed on the anti-allergic, hemostatic and antibiotic. The symptoms disappeared in three weeks and the urogram returned normal. Discussions were made on pathogenesis of this case especially on its allergic nature. Emphasis was made on the facts that the change involved the entire urinary tract and the urogram was very interesting. Some literature was reviewed on these points.