Looking beyond the ordinary: Genital lupus

Jolly, Meenakshi; Patel, P M

doi:10.1002/art.22233

Cited by 12 publications

(5 citation statements)

References 89 publications

(203 reference statements)

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“…Risk factors for lupus cystitis include lupus enteritis, female sex, and anti‐dsDNA positivity . Our patient's nonhealing, noninfectious genital ulcers are consistent with lupus cystitis, given that such ulcers occur commonly in SLE .…”

Section: Differential Diagnosissupporting

confidence: 51%

A 53‐Year‐Old Man With Dysuria, Pyuria, and Genital Ulcers

Jimenez

Psutka

Stone

et al. 2016

Arthritis Care & Research

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A 53-year-old man with dysuria, pyuria, and genital ulcers. History of the present illnessThe patient developed dysuria and pain at the base of the penis 1 month before presenting to an outside hospital. His pain worsened and he developed fever, pyuria, and penile ulcers a couple of days prior to admission. The patient also noted light pink urine, which was concerning for hematuria. He was treated empirically for both chlamydia and herpes simplex virus (HSV) infections with doxycycline and acyclovir, respectively, but urine polymerase chain reaction assays for Chlamydia trachomatis and Neisseria gonorrhea were negative and a penile ulcer swab was negative for HSV. His diagnosis was amended to prostatitis and he was discharged on levofloxacin. Amoxicillin was added after his urine culture grew a group B Streptococcus species.He followed up in the urology clinic as an outpatient and underwent a transrectal ultrasound of the prostate, the results of which were not consistent with prostatitis. A computed tomographic scan of the pelvis with contrast demonstrated mild thickening of the bladder wall and perivesical stranding consistent with inflammation. He continued to have painful urination and pyuria, for which he was readmitted to the hospital 3 weeks later.During his second hospital admission, he underwent repeat cystoscopy that revealed a large necrotic mass at the bladder trigone. The mass obstructed both ureteral orifices. Transurethral resection of the trigonal mass was performed, with bilateral ureteral stent placement. Histologic examination of the surgical specimen was notable for acute suppurative inflammation and necrosis, without evidence of malignancy.Ulcerative lesions on the glans penis persisted. These were retested for HSV as well as for Lymphogranuloma venereum and Treponema pallidum, but all of these assays were negative. He was prescribed a topical glucocorticoid, which seemed to decrease the size of the ulcers.During his admission, his serum creatinine rose from baseline of 1.2 to 4.0 mg/dl. His acute kidney injury was attributed to the combination of contrast-induced renal injury and obstructive uropathy from his resected trigonal mass. His creatinine improved but did not normalize following placement of ureteral stents. He developed a fever to 1018F and was started on piperacillin and tazobactam with no clear genitourinary source of infection. An extensive serologic evaluation demonstrated that the patient was negative for rheumatoid factor, antinuclear antibodies (ANAs), cyroglobulins, human immunodeficiency virus infection, hepatitis A, B, and C, and anti-neutrophil cytoplasmic antibodies (ANCA). The serum angiotensinconverting enzyme concentration was normal. Cultures of his penile lesion grew few yeast, but were otherwise unremarkable. The patient was then transferred for further evaluation.The patient was admitted to the urology service with diagnoses of obstructive uropathy by a bladder mass of unknown etiology, pelvic pain, and penile ulcers. Examination of the urine sediment revealed n...

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Section: Differential Diagnosissupporting

confidence: 51%

A 53‐Year‐Old Man With Dysuria, Pyuria, and Genital Ulcers

Jimenez

Psutka

Stone

et al. 2016

Arthritis Care & Research

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“…The frequencies of visits for disease of female genital organ, urinary tract, and the ear were also found to be elevated in patients during the pre-SLE period. Although these organ systems could directly be affected by SLE [29], [30], the increased visits might also be caused by infections of these organs. A study based on the Taiwan NHI database demonstrated an increased risk of tuberculosis in patients before their diagnosis of SLE [31].…”

Section: Discussionmentioning

confidence: 99%

Patterns of Ambulatory Medical Care Utilization and Rheumatologist Consultation Predating the Diagnosis of Systemic Lupus Erythematosus: A National Population-Based Study

et al. 2014

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ObjectiveTo investigate the records of ambulatory medical care from patients predating the diagnosis of systemic lupus erythematosus (SLE) using nationwide, population-based claims data.MethodsThe frequencies and costs of ambulatory medical care utilization in 337 newly-diagnosed SLE cases between 2004 and 2010, identified from Taiwan's National Health Insurance Research Database, were compared with 1,348 controls who were frequency matched for sex, age, and the catastrophic illness certificate application year of the cases.ResultsPatients with SLE had a median frequency of ambulatory medical care utilization compared with controls one year prior to the index date (22 vs. 2, P<0.001). The differences were significant throughout all eight annual periods. Similarly, the inflation-adjusted costs of ambulatory medical care utilization in patients with SLE increased annually over the study period, from a median of US$18 eight years prior to the index date to US$680 one year prior to the index date. Diseases of the respiratory system (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 460–519), digestive system (ICD-9-CM codes 520–579), musculoskeletal system and connective tissue (ICD-9-CM codes 710–739, excluding 710.0), and skin and subcutaneous tissue (ICD-9-CM codes 680–709) were the top four common causes of visits in the 0.5 to 2 year period preceding the index date and percentages of SLE patients suffered from these disorders increased progressively over the study period. Only 56.4% of the patients with SLE had consulted a rheumatologist and most of the serology tests were done within one year predating the index date.ConclusionsIncreased frequencies and costs of ambulatory care utilization among Taiwanese patients with SLE occurred several years predating their definitive SLE diagnosis. When multisystemic disorders are presented in young female patients, the possibility of SLE should be considered and screened with tools such as the antinuclear antibody test.

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“…Vulval involvement in LE is rare but discoid LE has been reported (Bilenchi 2004) and there is one case report of a patient with systemic LE who developed a plaque of cutaneous lupus on the left labium majus (Jolly & Patel 2006). …”

Section: Lupus Erythematosusmentioning

confidence: 99%