Lupus cystitis. report of a case

Abstract

42歳女。SLEで経過を観察中に食思不振となり当院内科を受診。精査中に水腎症を発見され泌尿器科紹介となった。IVPで両側水腎水尿管を認めた。CTでは腹水貯留と粘膜と漿膜に造影効果を有する腸管壁および膀胱壁の肥厚を認めた。ラッシクス負荷レノグラムは両側腎とも正常であった。膀胱生検では間質の浮腫, 繊維化と炎症細胞浸潤を認めた。膀胱内圧測定でほぼ正常であった。ループス膀胱炎の診断でプレドニソロン40mgを開始した。CT上, 膀胱壁, 腸管壁の肥厚も消失し貧血も改善した。左水腎症は改善したが右尿管狭窄が悪化したため尿管ステントを挿入しステロイド療法を継続しながら経過を観察している

A 42-year-old female with a history of systemic lupus erythematosus (SLE) visited the Department of Internal Medicine at our hospital complaining of anorexia. Hydronephrosis was diagnosed, and she was referred to our department for further evaluation. Intravenous pyelography (IVP) revealed bilateral hydronephrosis and hydroureters. Computerized tomography (CT) showed retention of ascitic fluid and thickening of the intestinal and bladder walls with contrast effects in the serosa and mucosa. Lasix-loaded renography showed that both kidneys were normal. Examination of a biopsy specimen revealed interstitial edema, fibrosis, and infiltration of inflammatory cells. Cystometry showed normal intravesical pressure. A diagnosis of lupus cystitis was made and administration of 40mg of prednisolone was started. The anemia was ameliorated, and thickening of the bladder and intestinal walls was no longer seen on CT. Hydronephrosis of the left kidney was less prominent. However, aggravation of the right ureteral stenosis was noted, and a stent was inserted in the stenosed ureter. Stenosis was successfully relieved by the stent, and internal drainage was established. The patient is still receiving steroids and is being followed at our department. Twenty-two reported cases of lupus cystitis in Japan are reviewed.