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Table of Contents
CASE REPORT
Year : 2015  |  Volume : 7  |  Issue : 3  |  Page : 414-415  

Lupus cystitis presenting with urinary symptoms


1 Department of Urology, University of California, San Francisco, USA
2 Department of Urology, University of California, San Francisco, USA; Department of Urology, King Abdul Aziz University, Jeddah, Saudi Arabia

Date of Submission30-Jan-2015
Date of Acceptance16-Feb-2015
Date of Web Publication9-Jul-2015

Correspondence Address:
Amjad Alwaal
400 Parnassus Avenue, A633, San Francisco, CA 94143-0738

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DOI: 10.4103/0974-7796.157961

PMID: 26229342

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   Abstract 

We present a case of a young woman presenting with irritative lower urinary tract symptoms and microscopic hematuria who was diagnosed with systemic lupus erythematosus (SLE). Abdominal ultrasound revealed bilateral hydronephrosis and a thickened bladder wall. Cystoscopic evaluation revealed severe diffuse inflammation, erythema and hemorrhage at the trigone with punctate extensions to the bladder base. She was treated with prednisone and mycophenolate mofetil with improvements in her symptoms and ultrasound findings. Lupus cystitis is a rare manifestation of SLE.

Keywords: Cystitis, lower urinary tract symptoms, systemic lupus erythematosus


How to cite this article:
Harris CR, Alwaal A, Zaid UB, Tasian GE, Breyer BN. Lupus cystitis presenting with urinary symptoms. Urol Ann 2015;7:414-5

How to cite this URL:
Harris CR, Alwaal A, Zaid UB, Tasian GE, Breyer BN. Lupus cystitis presenting with urinary symptoms. Urol Ann [serial online] 2015 [cited 2019 Apr 23];7:414-5. Available from: http://www.urologyannals.com/text.asp?2015/7/3/414/157961


   Introduction Top


Systemic lupus erythematosus (SLE), is a systemic autoimmune disease with rare involvement of the genitourinary system. We present here a rare case report of a female patient with SLE involvement of the bladder.


   Case report Top


A 28-year-old Asian woman presented to the emergency department with acute onset of seizures, abdominal pain, facial rash, dysuria, urinary urgency, and fatigue. She denied gross hematuria, fevers, chills, vomiting. Physical exam revealed a malar rash. Her abdomen was soft, but diffusely tender with mild left costovertebral angle tenderness. Her vital signs were within normal limits. Her serum creatinine was elevated to 1.4 mg/dL from a baseline of 1 mg/dL and urinalysis showed isolated microhematuria. Further workup included a positive anti-double-stranded DNA antibody leading to the diagnosis of SLE. Workup of her abdominal pain included an abdominal ultrasound, which revealed mild bilateral hydroureteronephrosis and thickened bladder wall [Figure 1].
Figure 1: Abdominal ultrasound demonstrating thickened bladder wall

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Based on this radiographic finding, the urology service was consulted. Cystourethroscopy with bilateral retrograde pyelography was performed to evaluate for ureteral and distal obstruction. Cystoscopic evaluation of the bladder revealed severe diffuse inflammation, erythema and hemorrhage at the trigone with punctate extensions to the bladder base [Figure 2]. The remainder of the bladder appeared normal, and the ureters were normal on retrograde pyelography.

Given her clinical presentation and laboratory results, these cystoscopic findings were consistent with lupus cystitis. The patient was started on prednisone and mycophenolate mofetil. One month later, the patient's urinary symptoms and microhematuria resolved. Her creatinine improved to 1.2 mg/dL and renal ultrasound showed resolution of hydronephrosis and improvement in the bladder wall thickening.
Figure 2: Cystoscopic evaluation of the bladder demonstrating severe diffuse inflammation, erythema and hemorrhage at the trigone with punctate extensions to the bladder base

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   Discussion Top


Systemic lupus erythematosus is a systemic autoimmune disease that can affect any part of the body. Overall, women with SLE are more likely to develop voiding dysfunction compared to the general population. [1] Lupus cystitis is a rare manifestation of SLE, and most reported cases are from East Asia. Patients typically present with irritative voiding symptoms and approximately 92% have associated the hydronephrosis. [2] Lupus cystitis often presents concurrently with gastrointestinal involvement (lupus enteropathy) but may also be the only manifestation as well. [3] Most patients do not require intervention and respond well to immunosuppressive therapy as demonstrated in our patient.

 
   References Top

1.
Yu HJ, Lee WC, Lee KL, Chen MY, Chen CY, Chen J. Voiding dysfunction in women with systemic lupus erythematosus. Arthritis Rheum 2004;50:166-72.  Back to cited text no. 1
    
2.
Shimizu A, Tamura A, Tago O, Abe M, Nagai Y, Ishikawa O. Lupus cystitis: A case report and review of the literature. Lupus 2009;18:655-8.  Back to cited text no. 2
    
3.
Asia S, Martellotto G, Belén R, Sesín AM, Gamróm S, Drenkard C. Obstructive uropathy as the only manifestation of flare in a patient with systemic lupus erythematosus and anti-phospholipid syndrome. Lupus 2008;17:46-9.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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