尿閉をきたした好酸球性膀胱炎の1例

Abstract

56歳女。頻尿, 残尿感を主訴に受診するも異常所見を認めず, 6ヵ月後の経過観察中に排尿時痛, 夜間尿失禁が出現し, 1ヵ月後に尿閉, 両側水腎症を認め, 精査目的入院となった。異常所見はなく血清クレアチニンの軽度上昇と膿尿を認めるも尿培養は陰性で尿道カテーテル留置により水腎症は速やかに改善した。1週間後のカテーテル抜去の数時間後に水腎症は再発した。病理組織学的所見では悪性所見はなく全ての粘膜下に好酸球を主体とする炎症, 細胞の浸潤を認めたため好酸性膀胱炎と診断した.廃用性膀胱萎縮防止のため尿道カテーテルを抜去し自己導尿を指導した。プレドニゾロン, マレイン酸クロルフェニラミンを開始して自排尿量は増加し, 治療3ヵ月後には著明に改善した。水腎症, 膀胱壁肥厚の消失, 粘膜不整部の消失を認め11ヵ月経過して明らかな再発は認めていない。

A 56-year-old woman was referred to our hospital presenting with urinary retention. Ultrasonography revealed bilateral hydronephrosis and magnetic resonance imaging of the pelvis showed diffuse thickening of the bladder wall. The hydronephrosis was improved by urethral balloon catheter. A cystoscopic examination revealed papillary lesions, polypoid yellow lesions and gross mucosal edema in the whole bladder. Pathological examination of transurethral punch biopsy showed no malignancy but inflammatory infiltration in the submucosa of bladder wall with many eosinophils. She performed clean intermittent self-catheterization and was treated with corticosteroids and antihistaminics. Three months after diagnosis, conservative treatment resulted in an excellent relief of symptoms, decrement of residual urine and remission of the bladder lesions in cystoscopy. In women with urinary retention, eosinophilic cystitis (EC) must be considered in the differential diagnosis. To our knowledge, this is the first case of EC presenting with urinary retention reported in the Japanese literature.