Lupus cystitis: An unusual presentation of systemic lupus erythematosus

Abstract

Lupus cystitis is a rare complication of systemic lupus erythematosus (SLE) and occurs in association with gastrointestinal symptoms. This rare disorder has been reported mainly from Japan. We report a 20 year old female who diagnosed as having SLE associated with paralytic ileus and chronic interstitial cystitis. Treatment with intravenous methylprednisolone, cyclophosphamide pulse therapy followed by oral prednisolone and azathioprine led to amelioration of manifestations. Later she developed lupus nephritis which was treated with mycophenolate mofetil.

Systemic lupus erythematosus of the urinary tract: focus on lupus cystitis

“…It was noted that more often the symptoms appearing first are gastrointestinal [ 23 ]. Patients may present symptoms such as abdominal pain, watery diarrhea, constipation, and nausea, which may result in vomiting [ 7 , 20 ]. These symptoms may lead to weight loss [ 3 , 24 ].…”

“…Mukhopadhyay et al [ 7 ] in 2014 described a case of bladder manifestation of lupus occurring in a 20-year-old patient in whom pulse therapy was applied, with methylprednisolone in combination with cyclophosphamide in a six-cycle regimen (methylprednisolone at a dose of 1 g/day, administered three days in a cycle; cyclophosphamide 500 mg/day, administered one time per cycle). Prednisolone was used in the intervals between the cycles.…”

“…Prednisolone was used in the intervals between the cycles. Later, after the reduction of symptoms, azathioprine was also added [ 7 ].…”

“…In lupus development, interstitial cystitis may also occur [ 1 – 4 ]. Lupus cystitis is a rare complication of SLE but may lead to permanent bladder dysfunction, and its complications may include irreversible impairment of renal function [ 7 ]. In 20–60% of patients with SLE, there occurs glomerulonephritis, which is defined as lupus nephritis or lupus nephropathy.…”

“…Kidney involvement in lupus is clearly correlated with ethnicity: the highest risk is found in Afro-Americans (40–69%) and Asians (47–53%), while in Caucasian patients the risk is lower (12–33%). Bladder involvement in the course of SLE is relatively rare [ 7 ]. It is estimated that it may affect 0.01–2% of all lupus patients, of whom 92% are women [ 3 , 4 , 8 , 9 ].…”