Isolierte Manifestation einer nekrotisierenden Vaskulitis an der Harnblase

Becker, Andreas; Astroza, Gastón; Quezada, Nicolás; Riaño, Carlos; Urrutia, Juan Manuel Gómez; Guzmán, Sergio

doi:10.1007/s00120-008-1769-3

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…Rheumatic causes of urogenital inflammation are important to consider. There are a series of case reports on vasculitis causing bladder inflammation and/or mass lesions with or without genital ulcers and urethritis . GPA is known to present throughout the urogenital tract and was strongly considered in this case, once infectious and malignant causes were excluded.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

Jimenez

Psutka

Stone

et al. 2016

Arthritis Care & Research

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“…(2005) [25]59/MBladderFatigue, sweats, weight lossNegElevatedNecrotizing vasculitis of small and large vesselsPrednisolone (F/u 3 months)Becker et al . (2008) [26]53/MBladderNoneNegElevatedNecrotizing vasculitis of small vesselsTURBT, prednisone, cyclophosphamide (F/u 1 month)Kassir et al . (2013) [27]31/MBladderFeverN/AElevatedNon-granulomatous, small and medium vessel thrombotic vasculitisTURBT (F/u 9 months)Fall et al .…”

Section: Discussionmentioning

confidence: 99%

“…The patients who did not have any systemic features underwent either a TURBT as well as therapy with prednisone and azathioprine, or treatment with steroids and cyclophosphamide without surgical excision [24, 28]. Of the other four patients, one underwent TURBT alone [27], two underwent TURBT as well as systemic therapy [24, 26], and one received prednisolone alone [25]. All six patients had no evidence of emergent systemic vasculitis over a mean follow-up of 17.2 months (median, 10.5 months).…”

Section: Discussionmentioning

confidence: 99%

Polyarteritis nodosa isolated to the testis and urinary bladder in the setting of cryptorchidism: a case report and literature review

Stewart¹,

Marcotte²,

Seidman³

et al. 2019

J Med Case Reports

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Background Polyarteritis nodosa is a small vessel to medium vessel vasculitis that frequently presents with multi-organ involvement, but can sometimes be limited to single organs such as the testes. Patients often require treatment with glucocorticoids, plus or minus additional immunosuppressive therapy depending on the severity of the disease. We describe a rare case of polyarteritis nodosa involving the right testis and urinary bladder without other systemic features of vasculitis. Case presentation A previously healthy 54-year-old First Nations Canadian man presented with intermittent gross hematuria. He underwent surgical excision of his right testis for cryptorchidism and a transurethral resection of a bladder mass. Histology showed an active medium vessel vasculitis in both organs. On extensive clinical, laboratory, and radiographic review, he had no systemic features of vasculitis. On 2-year follow-up, he has not required any systemic therapy and has not developed further symptoms. Conclusion Single organ polyarteritis nodosa can sometimes be managed with surgical excision of the involved organ alone. Although our patient had two organs involved, we extrapolated the results of our literature search to guide his care. This case highlights the potential for surgical excision to cure polyarteritis nodosa despite the involvement of two organs in the absence of symptoms and signs of systemic vasculitis.

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“…Vasculitis of the urinary bladder is rare and may represent a manifestation of systemic disease. Isolated vasculitis is even rarer, and at presentation may cause a diagnostic dilemma because of its tumor-like appearance [1][2][3][4]. This study presents a case of isolated vasculitis of the bladder together with a note on prognosis.…”

Section: Introductionmentioning

confidence: 99%