Abstract
Systemic lupus erythematosus (SLE) frequently affects renourinary systems. However, involvement of lower urinary tract has been rarely mentioned in the literature. We describe two SLE patients with bladder symptoms with different pathogeneses. One patient who had taken 10 mg/day of prednisolone, presented with gastrointestinal symptoms preceding pollakisuria. Abdominal CT scan and intravenous pyelography revealed the thickening of the intestinal wall, bilateral hydroureters and hydronephrosis. Histological examination of the bladder wall confirmed interstitial cystitis that was consistent with the pathological features of lupus cystitis. Her symptoms and radiographic findings were markedly improved with pulse methylprednisolone therapy followed by oral prednisolone, 30 mg/day. Another patient, who had been medicated with 15 mg /day of prednisolone, presented with high fever and malar rash. Laboratory results suggested elevated activities of SLE. Although the dose of prednisolone was increased to 30 mg/day, dysuria along with neurological manifestations such as cognitive dysfunction, a positive Babinski response, and rectal incontinence developed. Radiography of the brain and spinal cord showed no abnormalities. Since urological examinations indicated motor paralytic bladder, we considered the symptoms to be neurolupus. Treatments with pulse methylprednisolone followed by 60 mg/day of prednisolone promptly alleviated her symptoms. Because delayed treatments often result in irreversible urinary dysfunction, we should not overlook lower urinary symptoms with different pathogeneses in SLE patients.
