1
|
Very Severe and Refractory Noninfectious Cystitis in Patients with Systemic Lupus Erythematosus: Potential Role of Rituximab Therapy. Case Rep Rheumatol 2021; 2021:6610111. [PMID: 33728086 PMCID: PMC7936892 DOI: 10.1155/2021/6610111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/02/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with various clinical manifestations, including, rarely, a form of interstitial cystitis (lupus cystitis, LC). LC can be asymptomatic and usually has discrete symptoms that improve with conventional therapies available for SLE and/or typical interstitial cystitis. A very severe and refractory form is rarely described. In this study, we present four patients with SLE and a very severe form of noninfectious cystitis refractory to the different forms of treatment described. The clinical descriptions of the cases, demographic factors, manifestations associated with SLE, and clinical and paraclinical manifestations related to cystitis, treatments, and outcomes are provided. A proposal for the pathogenesis of this condition is based on the common findings of these patients, including the fact that three were in SLE remission and all four receiving rituximab as induction and/or maintenance therapy.
Collapse
|
2
|
John K, Varughese K, Boaz RJ, George T. Lupus cystitis: unusual cause of renal failure in systemic lupus erythematosus. BMJ Case Rep 2019; 12:12/12/e233446. [PMID: 31862817 DOI: 10.1136/bcr-2019-233446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A 42-year-old woman presented with chronic fever, abdominal pain, intermittent loose stools and dysuria for 3 months. She had recently developed acute dyspnoea with acute kidney injury. She was found to have a contracted, thick-walled bladder with bilateral hydroureteronephrosis. She underwent bilateral percutaneous nephrostomies, following which her renal function recovered. She satisfied the clinical and immunological features of the Systemic Lupus International Collaborating Clinics criteria for systemic lupus erythematosus (SLE). She was initiated on immunosuppression. Lupus cystitis with a contracted bladder is an uncommon presentation of SLE.
Collapse
Affiliation(s)
- Kevin John
- Internal Medicine, Christian Medical College, Vellore, Vellore, Tamil Nadu, India
| | - Krupa Varughese
- Internal Medicine, Christian Medical College, Vellore, Vellore, Tamil Nadu, India
| | - Ranil Johann Boaz
- Urology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Tarun George
- Internal Medicine, Christian Medical College, Vellore, Vellore, Tamil Nadu, India
| |
Collapse
|
3
|
Koh JH, Lee J, Jung SM, Ju JH, Park SH, Kim HY, Kwok SK. Lupus cystitis in Korean patients with systemic lupus erythematosus: risk factors and clinical outcomes. Lupus 2015; 24:1300-7. [DOI: 10.1177/0961203315588575] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 05/05/2015] [Indexed: 02/02/2023]
Abstract
This study was performed to investigate the clinical characteristics of lupus cystitis and determine the risk factors and clinical outcomes of lupus cystitis in patients with systemic lupus erythematosus (SLE). We retrospectively reviewed 1064 patients at Seoul St. Mary’s Hospital in Seoul, Korea, from 1998 to 2013. Twenty-four patients had lupus cystitis. Lupus cystitis was defined as unexplained ureteritis and/or cystitis as detected by imaging studies, cystoscopy, or bladder histopathology without urinary microorganisms or stones. Three-fourths of patients with lupus cystitis had concurrent lupus mesenteric vasculitis (LMV). The initial symptoms were gastrointestinal in nature for most patients (79.2%). High-dose methylprednisolone was initially administered to most patients (91.7%) with lupus cystitis. Two patients (8.3%) died of urinary tract infections. Sixty-five age- and sex-matched patients with SLE who were admitted with other manifestations were included as the control group. Patients with lupus cystitis showed a lower C3 level ( p = 0.031), higher SLE Disease Activity Index score ( p = 0.006), and higher ESR ( p = 0.05) upon admission; more frequently had a history of LMV prior to admission ( p < 0.001); and less frequently had a history of neuropsychiatric lupus ( p = 0.031) than did patients with SLE but without lupus cystitis. The occurrence of lupus cystitis was associated with a history of LMV (OR, 21.794; 95% CI, 4.061–116.963). The median follow-up period was 3.4 years, and the cumulative one-year mortality rate was 20%. Complications developed in 33.3% of patients with lupus cystitis and were related to survival (log-rank p = 0.021). Our results suggest that the possibility of lupus cystitis should be considered when a patient with SLE and history of LMV presents with gastrointestinal symptoms or lower urinary tract symptoms. Development of complications in patients with lupus cystitis can be fatal. Thus, intensive treatment and follow-up are needed, especially in the presence of complications.
Collapse
Affiliation(s)
- J H Koh
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea
| | - J Lee
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea
| | - S M Jung
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea
| | - J H Ju
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea
| | - S-H Park
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea
| | - H-Y Kim
- Divison of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul St. Mary' Hospital, Seoul, South Korea
| | - S-K Kwok
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|