[A case of systemic lupus erythematosus (SLE) with a neurogenic bladder, successful treatment with intravenous cyclophosphamide pulse therapy].
A 46-year-old woman was diagnosed as having systemic lupus erythematosus (SLE) in 1990 and was treated with a daily maintenance dose of prednisolone (PSL). She suddenly developed urinary incontinence with a high grade fever and erythema of the arms and legs on May 10, 1998 and was admitted to our hospital. Laboratory findings on admission showed proteinuria, pancytopenia and hypocomplementemia. Anti-nuclear antibody, anti-DNA antibody and anti-Sm antibody were positive. Ultra-sonography after urination revealed dilatation of the bladder. Cystometrography showed an autonomous neurogenic bladder. The diagnosis of neurogenic bladder complicated by peripheral neurone disturbance associated with recurrence of SLE was made and intravenous methylprednisolone (m-PSL) pulse therapy (1000 mg/day) was initially administered for 3 days followed by 60 mg of daily per os PSL. Urinary incontinence did not improved. The same therapy was conducted 3 times with no response. Therefore, treatment was started with intravenous cyclophosphamide pulse therapy (500 mg/day) which resulted in marked improvement of urinary incontinence, hypocomplementemia, proteinuria and pancytopenia. This case developed a neurogenic bladder caused by lower neurone disturbance but did not show central nervous system lupus with upper neurone disturbance. Neurogenic bladder caused by lower neurone disturbance in SLE has rarely been reported. The vasculitis of SLE was probably responsible for this neuropathy and this case was successfully treated with intravenous cyclophosphamide pulse therapy.
Nakagawa
M
M
Department of Rheumatology, Taga General Hospital, Ibaraki.
Nishinarita
M
M
D003520:Cyclophosphamide / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D020551:Pulse Therapy, Drug; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology
D003520:Cyclophosphamide