診断・治療に難渋したループス膀胱炎

A case of lupus cystitis

　症例は55歳，女性。26歳時にsystemic lupus erythematosus（SLE）と診断された。麻痺性イレウスにて当院に入院となった。SLEの活動性の亢進はみられなかった。CTで両側の水腎症と膀胱壁の肥厚を認めた。膀胱生検では明らかな悪性所見はみられず，炎症細胞の浸潤を認めた。ステロイド治療に反応なく，膀胱容量は次第に低下したため，両側尿管皮膚瘻造設を行った。一連の病態はループス膀胱炎と考えられた。ループス膀胱炎はSLEの活動性亢進がなくとも発症しうるため注意が必要と考えられた。

　The patient was a 55-year-old woman who had been diagnosed as SLE at the age of 26. She was recently admitted to our hospital because of paralytic ileus. No sign of increase in SLE activity was noted. CT scans revealed bilateral hydronephrosis and thickening of the wall of the urinary bladder. Biopsy of the urinary bladder revealed no evidence of malignancy with interstitial fibrosis and inflammatory cell infiltrations. She did not respond to steroid therapy. Because her urinary bladder capacity decreased gradually,we performed bilateral percutaneous ureterostomy. The sequence of abnormalities noted in this case appeared to be due to lupus cystitis. Since lupus cystitis can develop even in the absence of increased SLE activity,lupus cystitis must be considered in the treatment of patients with SLE.（Rinsho Hinyokika 61：441-443,2007）