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1.
We describe a patient with systemic lupus erythematosus (SLE) and overlapping syndrome who had repeated gastrointestinal (GI) symptoms such as nausea, vomiting and malabsorption. With a subacute process, she developed paralytic ileus and contracted bladder, and died of perforation of the ileum. When 13 reported cases with lupus cystitis were reviewed, an extremely strong correlation between GI and urinary tract symptoms was observed, indicating the presence of a unique subgroup of SLE.  相似文献   

2.
Chronic interstitial cystitis and ureteral stenosis has occasionally been reported in systemic lupus erythematosus, mostly associated with gastrointestinal symptoms. We report a case of obstructive uropathy associated to chronic interstitial cystitis as the only manifestation of lupus flare in a patient with SLE and anti-phospholipid syndrome (APS) who had been in remission for many years. The development of chronic interstitial cystitis in patients with SLE and APS has not been previously reported. Histopathological study of her urinary bladder and ureteral meatus showed chronic inflammatory infiltrate in the subepithelium. Lack of significant lower urinary tract symptoms and gastrointestinal involvement were some of the factors that could have prevented an earlier diagnosis. Obstructive uropathy and renal insufficiency initially improved with immunosuppressive treatment and endoureteral protheses, but poor compliance to the therapy led to ominous ending.  相似文献   

3.
Chen MY  Lee KL  Hsu PN  Wu CS  Wu CH 《Lupus》2004,13(4):263-269
Lupus cystitis was rare but frequently resulted in obstructive uropathy and had a strong association with gastrointestinal (GI) symptoms. We treated six patients with systemic lupus erythematosus (SLE) and obstructive uropathy from January 1996 to December 2001 in a university hospital. Evidence of cystitis was obtained from cystoscopic biopsy or the presence of thickened bladder wall in image study. Similar to other reports, five patients had GI manifestations such as abdominal pain, nausea/vomiting, diarrhoea or ileus. In addition, mesenteric lymphadenopathy or pancreatitis was noted in three patients. Two patients had been treated for idiopathic thrombocytopenic purpura (ITP), four and 20 years ago, respectively. All six patients had antibodies to double-stranded DNA (dsDNA). Five patients each had antibodies to cardiolipin (IgG aCL) or SSA. The high prevalence of anti-SSA had also been reported in Chinese lupus patients with intestinal pseudo-obstruction, a clinical manifestation frequently associated with bilateral ureterohydronephrosis. Two patients died of intractable infection after the surgical procedures for persistent ureterohydronephrosis and both patients had antibodies to ribosomal P proteins. Lupus cystitis might not be so rare in Chinese patients with SLE. The diagnosis should be kept in mind when lupus patients have urinary and/or GI symptoms.  相似文献   

4.
A 13-year-old girl presented with abdominal pain, fever, dysuria, incontinence and pyuria and was subsequently diagnosed as having systemic lupus erythematosus (SLE) with extensive gastrointestinal involvement and an associated interstitial cystitis. Despite aggressive therapy with high dose prednisone and cyclophosphamide she developed a small bowel perforation and subsequently died. The combination of bowel symptoms and interstitial cystitis seems unique to the population with SLE, while the separate complication of bowel perforation carries an extremely poor prognosis in this group of patients.  相似文献   

5.
A 36-year-old Japanese woman who had been diagnosed as having systemic lupus erythematosus (SLE) at the age of 34 began to complain of severe bowel symptoms and developed severe hydroureteronephrosis. She had a history of idiopathic thrombocytopenic purpura. Biopsy specimens from her bladder showed interstitial cystitis. She was diagnosed as having lupus cystitis, and treated with intravenous methylprednisolone pulse therapy followed by oral prednisolone and ureter catheterization. Her urinary and bowel symptoms were alleviated and the level of hydroureteronephrosis improved. We note that cystitis could be a primary manifestation of SLE. Patients not only with SLE but also with some autoimmune diseases require careful urological evaluation when they complain of severe bowel symptoms.  相似文献   

6.
系统性红斑狼疮合并膀胱炎及尿路梗阻一例并文献复习   总被引:9,自引:1,他引:9  
目的提高对系统性红斑狼疮(SLE)合并膀胱炎及尿路梗阻的认识。方法报告1例特殊而临床少见的SLE合并膀胱炎、尿路梗阻及假性肠梗阻病例并复习相关文献。结果患者为37岁女性,SLE病史4年,出现膀胱刺激征1年,腹胀1个月;中段尿培养阴性;B超及膀胱镜示:膀朊壁增厚,膀胱容量减少,黏膜充血、水肿。X线及造影检查证实肠梗阻及尿路梗阻;激素及环磷酰胺治疗后膀胱炎及肠梗阻症状减轻。结论SLE合并的膀胱炎临床少见,属于间质性膀胱炎,是SLE合并尿路梗阻的最常见原因;SLE尿路梗阻常与假性肠梗阻同时出现,可能属于SLE的一个独特临床亚型;SLE合并肠梗阻病情严重,病死率高,临床上应予重视。  相似文献   

7.
A 50-year-old woman with a 4-year history of Evans syndrome was admitted to our hospital because of progressive nausea, appetite loss, body weight loss, diarrhea and abdominal pain. Abdominal ultrasonography revealed pleural effusion, ascites, bilateral hydronephrosis, dilatation of the bilateral ureter, and irregular wall thickness of the urinary bladder. Immunological studies revealed decreased complement components (C3; 72 mg/dl, C4; 7 mg/dl, CH50; 28.8 mg/dl), a x 80 antinuclear antibody titer (homogeneous pattern), antibody against single-stranded DNA 19 U/ml, anti-SS-A antibody over 500 U/ml and negativity for antibody against double-stranded DNA (anti-dsDNA Ab). Although the patient did not fulfill the criteria for systemic lupus erythematosus (SLE), we diagnosed her as having lupus cystitis. Bolus methylprednisolone (mPSL) therapy (1,000 mg mPSL over 3 days, div) was administered, followed by 60 mg PSL, and this led to immediate improvement of the patient's symptoms and laboratory data. Later, anti-dsDNA Ab became positive, and the patient thereby fulfilled the criteria for SLE. Lupus cystitis following Evans syndrome has rarely been reported. The present such case was treated successfully with bolus mPSL therapy.  相似文献   

8.
Emphysematous cystitis (EC) is a rare condition in which gas-forming organisms are active in the bladder wall and lumen. Most of the cases have been described in patients suffering from diabetes mellitus due to glucosuria and subsequent anaerobic fermentation of glucose. To our knowledge this condition has never been described in association with systemic lupus erythematosus (SLE). We report here the first case of EC during the course of a chronic lupus cystitis (LC) in a woman suffering from SLE and type-I diabetes mellitus.  相似文献   

9.
A patient with systemic lupus erythematosus (SLE) is described who displayed the unusual extraglomerular syndromes of interstitial cystitis with obstructive uropathy and severe secretory-type diarrhea with intestinal malabsorption. Pathologic investigations into the nature of these events revealed immunofluorescent deposits in blood vessel walls of the small intestine and urinary bladder. The patient's malabsorption state and cystitis with urinary obstruction regressed with therapy of the SLE. We are postulating that immune complexes from the circulation may deposit in blood vessel walls, and may be responsible for tissue injury in these sites and the clinical manifestations of this patient.  相似文献   

10.
目的 分析系统性红斑狼疮(SLE)相关肾盂输尿管积水的临床特点,提高早期发现SLE合并肾盂输尿管积水的能力.方法 回顾性分析本院2000-2008年SLE相关肾盂输尿管积水31例,总结其临床特点,对不同治疗时机下治疗效果进行比较,数据分析采用X2检验和t检验.结果 SLE相关肾盂输尿管积水占同期SLE住院病例1.26%(31/2468),同时合并慢性假性肠梗阻28例(90%);14例(45%)有膀胱刺激症状;双侧肾盂输尿管积水19例(61%),单侧肾盂输尿管积水8例(26%),动态观察由单侧发展至双侧肾盂输尿管积水4例(13%),双侧肾盂输尿管积水多合并膀胱壁增厚、膀胱容积变小;抗核抗体S型比例及抗SSA抗体阳性率高,均为14例(45%).31例患者均使用激素及免疫抑制剂治疗,11例完全恢复,3例无效,其中2例永久保留肾需造瘘术,1例行膀胱颈切开加输尿管膀胱再植术.结论 肾盂输尿管积水可以出现在膀胱刺激症状之前,常并发慢性假性肠梗阻,高S型ANA核型和抗SSA抗体阳性率可能是其重要免疫学特征,激素及免疫抑制剂治疗有效,早期发现、早期治疗可以改善预后.
Abstract:
Objective To improve the ability of rheumatologist to diagnose systemic lupus erythematosus (SLE) complicated with ureterohydronephrosis by analyzing the characteristics of clinical manifestations.Methods Patients with ureterohydronephrosis hospitalized in Peking Union Medical College Hospital between 2000 to 2008 were analyzed retrospectively. The clinical characteristics, serological findings, treatment and prognosis of these patients were reviewed. Comparisons between the groups were performed with X2 test and t-test. Results SLE patient with ureterohydronephrosis accounted for 1.26% of the SLE patients hospitalized in the same period. Twenty-eight patients presented with gastrointestinal symptoms, 14 patients suffered from bladder irritative symptoms. Nineteen patients were with bilateral ureterohydronephrosis, and 8 patients were with unilateral ureterohydronephrosis. Fourteen patients had stype positive ANA, 14 patients had positive antiSSA antibodies. All patients were treated with steroid and immune suppressive therapy, 11 patients were cured, while 3 patients had no improvement. Conclusion Ureterohydronephrosis isn't a very rare complication of SLE. SLE patients with ureterohydronephrosis often present with gastrointestinal symptoms and have high incidence of chronic intestinal pseudo obstruction. High ratio of stype ANA antibody and high positive rate of anti-SSA are most important characteristics in this subtype of SLE patients. The complications can be reversed if the patients are treated early and appropritaely.  相似文献   

11.
目的 分析系统性红斑狼疮(SLE)相关肾盂输尿管积水的临床特点,提高早期发现SLE合并肾盂输尿管积水的能力.方法 回顾性分析本院2000-2008年SLE相关肾盂输尿管积水31例,总结其临床特点,对不同治疗时机下治疗效果进行比较,数据分析采用X2检验和t检验.结果 SLE相关肾盂输尿管积水占同期SLE住院病例1.26%(31/2468),同时合并慢性假性肠梗阻28例(90%);14例(45%)有膀胱刺激症状;双侧肾盂输尿管积水19例(61%),单侧肾盂输尿管积水8例(26%),动态观察由单侧发展至双侧肾盂输尿管积水4例(13%),双侧肾盂输尿管积水多合并膀胱壁增厚、膀胱容积变小;抗核抗体S型比例及抗SSA抗体阳性率高,均为14例(45%).31例患者均使用激素及免疫抑制剂治疗,11例完全恢复,3例无效,其中2例永久保留肾需造瘘术,1例行膀胱颈切开加输尿管膀胱再植术.结论 肾盂输尿管积水可以出现在膀胱刺激症状之前,常并发慢性假性肠梗阻,高S型ANA核型和抗SSA抗体阳性率可能是其重要免疫学特征,激素及免疫抑制剂治疗有效,早期发现、早期治疗可以改善预后.  相似文献   

12.
Urinary bladder histologic changes were found in 16 of 35 necropsies from systemic lupus erythematosus (SLE) patients in whom adequate material was available for study. These included interstitial cystitis (n = 11), hemorrhage (n = 9), congestion (n = 7), vasculitis (n = 5), and perivenular infiltrate (n = 4). Abnormalities were found in only 5 of 30 control necropsies from patients with other diseases and in 4 of them these were hemorrhagic and chiefly due to indwelling catheters. SLE patients with histologic bladder changes were found to have pulmonary hemorrhage more frequently than those without. This suggests a common pathogenetic mechanism between interstitial cystitis and pulmonary hemorrhage in SLE.  相似文献   

13.
Lupus cystitis is a rare interstitial inflammatory disease of the bladder seen in systemic lupus erythematosus that usually occurs in association with gastrointestinal manifestations, and occasionally with central nervous system involvement. There are few reported pediatric cases. We describe this entity as the presenting manifestations of lupus in an adolescent female.  相似文献   

14.
We report two cases of systemic lupus erythematosus (SLE) diagnosed when acute peritonitis was appeared. Case 1 was a 20 year-old woman suffering from stomachache and right lower abdominal pain. Case 2 was a 40 year-old woman with diarrhea, epigastralgia, pollakisuria. In both cases, their peritoneal fluids were exudative with positive autoantibodies. After high dose steroid therapy, abdominal symptoms and ascites improved promptly. However, due to the complication of lupus nephritis, additional therapy was necessary. To characterize the feature of lupus peritonitis (LP), we examined the clinical and laboratory findings of LP from the literature. In patients with acute LP, abdominal pain, vomiting, diarrhea were significantly more common compared with chronic LP patients (P < 0.05), and fever, arthritis, central nervous system involvement and cystitis were more common. In patients with chronic LP, pleural effusion and pericardial effusion were more common compared with acute LP patients. Gastrointestinal manifestations such as abdominal pain, vomiting and diarrhea were more common in patients with acute LP compared with patients with chronic LP. Most patients with chronic LP were asymptomatic, ascites and serositis being the only clinical findings. The response to steroid therapy was better in acute LP.  相似文献   

15.
Intestinal pseudo-obstruction (IPO) is a rare but dangerous complication of systemic lupus erythematosus (SLE) when the patient has no other manifestations except gastrointestinal symptoms. We performed 1 patient with a 2-month history of recurrent vomiting and abdominal distension. She admitted past surgical histories of cesarean section and appendectomy. A physical examination revealed tenderness in the right lower abdominal on palpation and bowel sounds were weak, 2 to 3 bpm. An x-ray and CT of her abdomen showed intestinal obstruction. The initial diagnosis was adhesive intestinal obstruction. She received surgical treatment because her symptoms had gradually become more frequent and persistent. But she vomited again 2 weeks later after the surgery. Further immunology tests indicated that she had an IPO secondary to SLE. We treated the patient with methylprednisolone pulse for 3 days and followed by prednisone orally. The patient had a good response. Complete remission was achieved on 8 years follow-up.The importance of IPO secondary to SLE lies in an early diagnosis. After the diagnosis is established, immunosuppressive therapy should be the initial and first-line treatment, and surgical intervention is often disappointing and should be carefully avoided. It is necessary to enhance awareness of doctors to IPO secondary to SLE.  相似文献   

16.
Gastrointestinal manifestations of systemic lupus erythematosus   总被引:8,自引:0,他引:8  
Systemic lupus erythematosus (SLE) can involve any part of the gastrointestinal tract. In this review, we list the gastrointestinal manifestations of SLE and analyze current approaches in investigating and treating these common conditions. Abdominal symptoms and signs may be due to SLE or due to medications used in the treatment of SLE. In patients with abdominal pain and active SLE, it is critical to diagnose vasculitis or thrombosis with appropriate scanning and institute early immunosuppressive or surgical treatment.  相似文献   

17.
A 21-year-old man with systemic lupus erythematosus (SLE) who developed acute lupus peritonitis is described. Acute lupus peritonitis appeared during generalized lupus flare, with nausea, vomiting, frequent diarrhea, and abdominal tenderness with rebound and guarding. The patient was afebrile and had decreased bowel sounds. Abdominal ultrasonography and computed tomography revealed marked thickening of the gastric, duodenal, and jejunal walls, massive intraluminal fluid collection, and increasing ascites. Gastrointestinal endoscopy showed edematous mucosa with multiple erosions of the stomach and duodenum. The ascitic fluid was remarkable for low complement levels and elevated anti-DNA antibody. These manifestations of acute lupus peritonitis resolved after steroid pulse therapy with methylprednisolone. We should consider acute lupus peritonitis in a patient with SLE when abdominal symptoms are severe. Experience with our patient indicates that steroid pulse therapy is effective for this rare but severe manifestation of SLE.  相似文献   

18.
We report a patient with systemic lupus erythematosus (SLE) who showed periodic peritonitis with spontaneous remission. She showed compound heterozygous mutations in the MEFV gene, leading to the diagnosis of familial Mediterranean fever (FMF). Oral colchicine successfully reduced the severity and frequency of her peritonitis. SLE occasionally manifests abdominal symptoms, but in cases with periodic peritonitis, associated FMF should be considered as a possible cause.  相似文献   

19.
OBJECTIVE: To determine the causes of acute abdominal pain in systemic lupus erythematosus (SLE) and to compare the clinical and laboratory data, especially antiphospholipid antibodies and the SLE Disease Activity Index (SLEDAI), between lupus enteritis (gastrointestinal vasculitis) and acute abdominal pain without lupus enteritis in patients with SLE. METHODS: A retrospective study was carried out for all patients admitted with SLE from 1993 to March 2001. The SLEDAI and laboratory data were collected at the time of diagnosis of SLE and at the time of acute abdominal pain. Lupus enteritis (gastrointestinal vasculitis) was diagnosed by clinical investigation and abdominal computed tomographic findings. RESULTS: Chart review identified 175 patients (20 male, 155 female) who had been admitted with SLE. Of these patients, 38 (22%) presented with acute abdominal pain. Lupus enteritis was the most common cause of acute abdominal pain. Patients were divided into three groups: group 1: lupus enteritis (n=17), group 2: acute abdominal pain without lupus enteritis (n=21), and group 3: SLE without acute abdominal pain (n=137). There was no difference in age and sex among the three groups. Antiphospholipid, anti-RNP, anti-Sm, anti-Ro, and anti-La antibodies did not differ among the three groups. There was no difference in the SLEDAI at the time of diagnosis and at the time of acute abdominal pain between groups 1 and 2. Complement, erythrocyte sedimentation rate, C reactive protein, and anti-dsDNA measured at the time of acute abdominal pain did not differ between groups 1 and 2. A drop in the white blood cell count at the time of abdominal pain was more prominent in group 1 than group 2. In lupus enteritis, the jejunum and ileum were the sites most commonly affected. Rectal involvement was rare. Even though four patients relapsed, all the patients with lupus enteritis, including those who relapsed, responded well to corticosteroid. CONCLUSION: Lupus enteritis is the most common cause of acute abdominal pain in SLE. All patients with lupus enteritis responded well to a high dose of a corticosteroid without surgical intervention. The SLEDAI and laboratory data, except leucopenia, do not correlate with the occurrence of lupus enteritis.  相似文献   

20.
Patients with systemic lupus erythematosus (SLE) are reported to have an increased risk of malignancy, especially lymphoproliferative disorders. We decribe the occurrence of ileocaecal intussusception secondary to Burkitt’s lymphoma in a patient with SLE. A 23-year-old woman, who had been diagnosed with SLE 2 years ago, developed intermittent abdominal pain with a palpable mass. Computed tomography and a double-contrast barium enema showed a lobulated mass with intussusception at the ileocaecal junction. Right hemicolectomy and splenectomy was performed after histopathological examinations on colonoscopic biopsy revealed Burkitt’s lymphoma. Fourteen months after chemotherapy, there is no evidence of recurrence of the Burkitt’s lymphoma. When a patient with SLE has abdominal complaints, besides serositis, lupus enteritis such as peptic ulcer disease, mesenteric vasculitis with or without complications and pancreatitis, we have to consider intussusception secondary to gastrointestinal lymphoma as one of the differential diagnoses. Therefore, we should thoroughly investigate patients with SLE presenting with abdominal pain and not simply consider it a feature of lupus enteritis until other causes have been ruled out. Received: 14 September 1998 / Accepted: 21 December 1998  相似文献   

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