Asymptomatic Lupus Cystitis with Bilateral Hydronephrosis

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.

Ureteritis associated with systemic lupus erythematosus: a case report

“…Lupus cystitis and damage to the ureters is a relatively rare complication of SLE, and its clinical features remain obscure. 1,3,6–9 Generally, ureteritis refers to inflammatory changes in the ureter caused by bacterial invasion, and it mainly manifests as lower back pain, hematuria, fever, and urinary irritation. However, the underlying pathological basis of SLE-associated ureteritis is vasculitis.…”

“…Injury of the urinary system often manifests as lupus nephritis, and relevant bladder and ureter injury have been reported in previous studies with a low incidence. 1,2 Bladder or ureter injury may be the first symptom of SLE but it often appears during disease complications or recurrence. It is characterized by frequent or urgent urination, inadequate urination, or dysuria, ultimately causing bilateral dilatation of ureters and hydronephrosis.…”