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Santacruz JC, Pulido S, Arzuaga A, Mantilla MJ, Londono J. Lupus Cystitis, From Myth to Reality: A Narrative Review. Cureus 2021; 13:e20409. [PMID: 35047251 PMCID: PMC8757392 DOI: 10.7759/cureus.20409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/05/2022] Open
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Li C, Huang F, Wang Y, Tian M. Ureteritis associated with systemic lupus erythematosus: a case report. J Int Med Res 2021; 49:300060520987944. [PMID: 33530797 PMCID: PMC7871056 DOI: 10.1177/0300060520987944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report herein an unusual case of systemic lupus erythematosus in a 35-year-old woman who developed acute abdominal pain while hospitalized. Abdominal computed tomography (CT) scan with enhancement indicated long-segment inflammatory lesions in the right ureter. The patient received spasmolytic and analgesic drugs with poor effect and continued to have persistent severe abdominal pain and signs of peritonitis. We suspected that the patient had acute abdominal disease, but no abnormality was detected during laparoscopic surgery. Therefore, we considered the possibility of right upper urinary tract hydronephrosis; the patient’s abdominal pain was relieved after double-J tube implantation. The patient’s clinical symptoms improved after hormone and mycophenolate mofetil therapy for 1 year, and all laboratory indicators returned to normal. Reexamination by abdominal CT showed that the long-segment inflammatory lesions of the right ureter had resolved. Early identification and diagnosis are important for ureteritis associated with systemic lupus erythematosus.
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Affiliation(s)
- Chunyan Li
- Department of Nephrology and Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P. R. China
| | - Fei Huang
- Department of Nephrology and Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P. R. China
| | - Yu Wang
- Department of Nephrology and Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P. R. China
| | - Mei Tian
- Department of Nephrology and Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P. R. China
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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.
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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.
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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
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Aziza Bawazier L. Asymptomatic Lupus Cystitis with Bilateral Hydronephrosis. Case Rep Nephrol Dial 2018; 8:192-197. [PMID: 30345278 PMCID: PMC6180275 DOI: 10.1159/000493090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/20/2018] [Indexed: 12/13/2022] Open
Abstract
Lupus cystitis is a rare complication of systemic lupus erythematosus (SLE). It is characterized by an increase in bladder wall thickness and may be associated with hydroureteronephrosis. Reports, mostly from East Asian countries, indicate that lupus cystitis usually presents with gastrointestinal tract symptoms such as diarrhea, nausea, or abdominal pain. Lower urinarytract symptoms such as dysuria, nocturia, polyuria, and suprapubic pain are also common presenting symptoms. We report a 22-year-old female patient who presented at Cipto Mangunkusumo Teaching Hospital in Indonesia, with profuse and prolonged vaginal bleeding without any other accompanying symptoms. She had a history of polyarthralgias, fever, bleeding gums, anemia, and thrombocytopenia 3 months earlier. Abdominal ultrasound examination revealed bilateral hydronephrosis and a thickened bladder wall; the other organs were normal. Laboratory examination confirmed the diagnosis of SLE complicated by lupus nephritis and lupus cystitis. The patient responded well to the treatment with methylprednisolone. The vaginal bleeding stopped within 2 days, and the laboratory parameters improved. She was discharged on oral methylprednisolone and is scheduled for detailed workup after 1 month.
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Affiliation(s)
- Lucky Aziza Bawazier
- Department of Internal Medicine, Cipto Mangunkusumo National Teaching Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Systemic lupus erythematosus of the urinary tract: focus on lupus cystitis. Reumatologia 2018; 56:255-258. [PMID: 30237631 PMCID: PMC6142029 DOI: 10.5114/reum.2018.77978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023] Open
Abstract
Systemic lupus erythematosus (SLE) frequently manifests as urinary tract disease, most commonly in the form of lupus nephritis. Bladder involvement in the disease course takes a subclinical form and may affect both children and adults. Lupus cystitis can precede SLE diagnosis and may present with very unspecific urinary and digestive tract symptoms or no symptoms at all. The exact mechanism of bladder inflammation in lupus is not fully understood; however, histopathological studies suggest a possible role of immune complex-mediated small vessel vasculitis. Lupus cystitis is a rare SLE manifestation, but poses a challenge for physicians, due to its complex diagnostics and treatment.
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Maruyama A, Nagashima T, Iwamoto M, Minota S. Clinical characteristics of lupus enteritis in Japanese patients: the large intestine-dominant type has features of intestinal pseudo-obstruction. Lupus 2018; 27:1661-1669. [PMID: 30028259 DOI: 10.1177/0961203318785770] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was performed to investigate the clinical characteristics of lupus enteritis in Japanese patients with systemic lupus erythematosus (SLE). A total of 481 patients with SLE admitted to our hospital between 2001 and 2015 were retrospectively reviewed. Diagnosis of lupus enteritis was based on the following three criteria: (1) abdominal symptoms, (2) diffuse long-segment bowel thickening and (3) a requirement for glucocorticoid therapy. Lupus enteritis was identified in 17 patients (3.5%) and there were two distinct types: small intestine-dominant and large intestine-dominant. Significant differences between the two types were noted with respect to the age, frequency of biopsy-proven lupus nephritis, frequency of rectal involvement, maximum bowel wall thickness, and requirement for steroid pulse therapy. Among patients with large intestine-dominant lupus enteritis, 60% had extra-intestinal symptoms (hydroureter, bladder wall thickening, and bile duct dilatation) that are known complications of intestinal pseudo-obstruction. Two patients with large intestine-dominant lupus enteritis developed intestinal pseudo-obstruction either before or after diagnosis of lupus enteritis. Five patients (29%) developed recurrence during a median observation period of 7.2 years (1.4-14.4 years). In conclusion, large intestine-dominant lupus enteritis resembles intestinal pseudo-obstruction and these two diseases may have a common pathogenesis.
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Affiliation(s)
- A Maruyama
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - T Nagashima
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - M Iwamoto
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - S Minota
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
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John G, Avouac J, Piantoni S, Polito P, Fredi M, Cozzi F, Airò P, Truchetet ME, Franceschini F, Allanore Y, Chizzolini C. Prevalence and Disease-Specific Risk Factors for Lower Urinary Tract Symptoms in Systemic Sclerosis: An International Multicenter Study. Arthritis Care Res (Hoboken) 2018; 70:1218-1227. [DOI: 10.1002/acr.23454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/17/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Gregor John
- Hôpital Neuchâtelois, La Chaux-de-Fonds, Switzerland, and Geneva University Hospitals; Geneva Switzerland
| | | | | | | | | | | | | | - Marie-Elise Truchetet
- CNRS-UMR 5164 Immuno Concept, Bordeaux University and Bordeaux Hospital; Bordeaux France
| | | | | | - Carlo Chizzolini
- University Hospital and School of Medicine, University of Geneva; Geneva Switzerland
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John G, Allanore Y, Polito P, Piantoni S, Fredi M, Avouac J, Franceschini F, Truchetet ME, Cozzi F, Airo P, Chizzolini C. The limited cutaneous form of systemic sclerosis is associated with urinary incontinence: an international multicentre study. Rheumatology (Oxford) 2017; 56:1874-1883. [DOI: 10.1093/rheumatology/kex230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Indexed: 12/19/2022] Open
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Martin M, Meaux-Ruault N, Magy-Bertrand N, Beraud G, Parratte B, Roblot P. Anal incontinence and vesico-sphincter events in systemic sclerosis: An epidemiologic bicentric cohort study. Semin Arthritis Rheum 2016; 46:124-32. [PMID: 27131838 DOI: 10.1016/j.semarthrit.2016.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/16/2016] [Accepted: 03/25/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To estimate the frequency and severity of anal incontinence and vesico-sphincter events, associated factors, and impact on the quality of life of patients with systemic sclerosis. METHODS Questionnaires assessing anal incontinence (Miller score), vesico-sphincter events (Urogenital Distress Inventory) and quality of life [Short Form Health Survey 36v2 (SF-36), and Hospital Anxiety and Depression Scale] were mailed to 139 patients with systemic sclerosis at the university hospitals of Besançon and Poitiers, France. Clinical data were collected from the medical records to identify risk factors. RESULTS Among the 121 (87%) responders, severe vesico-sphincter events or severe anal incontinence occurred in 3.4% and 12.4% of cases, respectively. Frequent urination (66.3%) and anal incontinence to gas (50.4%) were the most frequent symptoms. Anal incontinence was associated positively with vesico-sphincter events, unrelated to obstetrical factors. No correlations were seen with age, sex, or systemic sclerosis characteristics. In multivariate analysis, moderate or severe vesico-sphincter events was associated with higher anxiety and depression scores and lower SF-36 scores; the same results were observed for anal incontinence, but did not reach significance. CONCLUSION Vesico-sphincter events and anal incontinence are common in systemic sclerosis, and sometimes severe, with a potential negative impact in quality of life. These results will be confirmed by a case-control study with dynamic and manometric assessment, and could legitimate a systematic screening to ensure early therapy and multidisciplinary individual management.
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Affiliation(s)
- Mickaël Martin
- Department of Internal Medicine, Besancon University Hospital, BESANCON Cédex, France.
| | - Nadine Meaux-Ruault
- Department of Internal Medicine, Besancon University Hospital, BESANCON Cédex, France
| | - Nadine Magy-Bertrand
- Department of Internal Medicine, Besancon University Hospital, BESANCON Cédex, France
| | - Guillaume Beraud
- Department of Internal Medicine, Infectious and Tropical Diseases, Poitiers University Hospital, Poitiers, France
| | - Bernard Parratte
- Department of Physiotherapy and Rehabilitation, Besancon University Hospital, BESANCON Cédex, France
| | - Pascal Roblot
- Department of Internal Medicine, Infectious and Tropical Diseases, Poitiers University Hospital, Poitiers, France
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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.
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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
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Jimenez X, Psutka SP, Stone JH, Carruthers MN. A 53-Year-Old Man With Dysuria, Pyuria, and Genital Ulcers. Arthritis Care Res (Hoboken) 2015; 68:1371-7. [PMID: 25989159 DOI: 10.1002/acr.22617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/12/2015] [Accepted: 05/05/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Xavier Jimenez
- Pennsylvania Hospital of the University of Pennsylvania, Philadelphia
| | | | - John H Stone
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mollie N Carruthers
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Liu B, Fu DW. Low compliance bladder plays a role in hydronephrosis in lupus cystitis: a case report. Lupus 2014; 23:829-32. [PMID: 24596124 DOI: 10.1177/0961203314526440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/10/2014] [Indexed: 11/16/2022]
Abstract
Lupus cystitis is uncommon in patients with systemic lupus erythematosus (SLE). Lupus cystitis is usually associated with hydronephrosis. To our knowledge, it is considered to be due to distal ureteral obstruction at the ureterovesical junction. However, in a Chinese female, we found low compliance bladder played a role in hydronephrosis.
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Affiliation(s)
- B Liu
- Department of Urology, First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning, China
| | - DW Fu
- Department of Urology, First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning, China
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De Siqueira J, Mangera A, Venugopal S, Edhem I. Cystectomy for obstructive uropathy secondary to lupus cystitis: a learning point for urologists? JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415813494201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present the case of a 72-year-old woman with obstructive uropathy secondary to interstitial cystitis-like pathology as the presenting features of systemic lupus erythematosus (SLE). After her initial presentation with visible haematuria, she was shown to have hydroureteronephrosis and a bulky bladder mass. Histology of bladder biopsies demonstrated severe inflammation. Following unsuccessful attempts to stent the ureters, worsening renal function and a concern regarding possible malignancy, a cystectomy and ileal conduit were performed. Final histology showed her bladder had only benign inflammatory changes. Subsequent investigations led to a diagnosis of SLE. We suggest that in cases of obstructive uropathy in association with severe inflammation of the bladder, lupus cystitis should be considered at an early stage and managed with steroids in the first instance. This may lead to resolution of the underlying pathology and thus avoid the need for urinary diversion and cystectomy.
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Affiliation(s)
| | - A Mangera
- Rotherham District General Hospital, Rotherham, UK
| | - S Venugopal
- Rotherham District General Hospital, Rotherham, UK
| | - I Edhem
- Rotherham District General Hospital, Rotherham, UK
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Tan TC, Wansaicheong GKL, Thong BYH. Acute onset of systemic lupus erythematosus with extensive gastrointestinal and genitourinary involvement. Lupus 2012; 21:1240-3. [DOI: 10.1177/0961203312455111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lupus enteritis may occur as an acute presentation of systemic lupus erythematosus (SLE), and is not uncommonly associated with acute uretero-cystitis and/or hydronephrosis. Extensive involvement of the gastrointestinal tract from the stomach to the rectum in acute SLE is uncommon. We describe a 22-year-old Chinese female who presented with acute extensive gastrointestinal and genitourinary involvement who recovered following pulse intravenous methylprednisolone and cyclophosphamide. A high index of clinical suspicion is required to arrive at the diagnosis of SLE where only acute gastrointestinal and genitourinary manifestations are predominant, and other clinical, haematological and biochemical features of SLE are absent.
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Affiliation(s)
- T-C Tan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - GK-L Wansaicheong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - BY-H Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
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