Lupus cystitis presenting with hidronephrosis and gastrointestinal involvement

Abstract Introduction: Lupus cystitis is a rare manifestation of systemic lupus erythematosus, characterized by thickening of the bladder wall, associated with ureterohydronephrosis. In several cases gastrointestinal symptoms are the main manifestation. The optimal immunosuppressive regimen is still unknown. Methods: 16-year-old girl with systemic lupus erythematosus was admitted with dysuria, renal impairment, diarrhea, abdominal pain, nausea and vomiting. An abdominal CT scan demonstrated moderate bilateral dilation from the pelvis to the ureterovesical junction, and the bladder exhibited reduced capacity and diffusely thickened walls. A diagnosis of chronic interstitial cystitis was performed and treatment with high dose methylprednisolone resulted in a significant relief of gastrointestinal and urinary symptoms and a reduction of the bladder thickness with improvement of their capacity. Conclusion: Lupus cystitis is a rare and underdiagnosed urinary manifestation of LES and the presence of mild urinary symptoms and abdominal pain may alert about this possibility.引言：狼疮性膀胱炎是系统性红斑狼疮（systemic lupus erythematosus，SLE）的罕见临床表现，以膀胱壁增厚为特征，常合并输尿管肾盂积水（ureterohydronephrosis）。部分病例中，胃肠道症状可作为主要临床表现。目前其最优免疫抑制治疗方案尚未明确。 方法：1例16岁系统性红斑狼疮女性患者，因排尿困难、肾功能损害、腹泻、腹痛、恶心呕吐入院。腹部CT检查显示双侧肾盂至输尿管膀胱连接段中度扩张，膀胱容量减小且壁弥漫性增厚。确诊为慢性间质性膀胱炎后，给予大剂量甲泼尼龙治疗，患者胃肠道及泌尿系统症状显著缓解，膀胱壁厚度减轻，容量得以改善。 结论：狼疮性膀胱炎是系统性红斑狼疮（SLE）一种罕见且易漏诊的泌尿系统表现，轻度泌尿系统症状与腹痛可提示本病的可能。