title: Autoimmune hemolytic anemia associated with renal urothelial cancer: A case report and literature review.
abstract: BACKGROUND
  Autoimmune hemolytic anemia (AIHA) is hemolytic anemia characterized by autoantibodies directed against red blood cells. AIHA can be induced by hematological neoplasms such as malignant lymphoma, but is rarely observed in the urological field. We report a case of renal urothelial cancer inducing Coombs-positive warm AIHA and severe thrombocytopenia that was responsive to nephroureterectomy.
  
  
  METHODS
  A 52-year-old man presented with a 1-month history of general weakness and dizziness. Hemoglobin level was 4.2 g/dL, and direct and indirect Coombs tests both yielded positive results. Abdominal computed tomography revealed huge left hydronephrosis due to a renal pelvic tumor measuring 4.0 x 4.0 x 3.0 cm, and renal regional lymph-node involvement was also observed and suspected as metastasis. Corticosteroid therapy was administered, and nephroureterectomy was performed. After surgical resection, the hemoglobin level gradually normalized, and direct and indirect Coombs tests yielded negative results. We thus diagnosed warm AIHA associated with renal urothelial cancer.
  
  
  CONCLUSIONS
  To the best of our knowledge, this represents the first report of AIHA associated with renal urothelial cancer and severe thrombocytopenia responsive to nephroureterectomy. Renal urothelial cancer needs to be included in the differential diagnoses for warm AIHA, and nephroureterectomy represents a treatment option for AIHA.
authors.affiliation: Department of Urology, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. shujiisotani@gmail.com.
authors.forename: Shuji
authors.initials: S
authors.lastname: Isotani
authors.affiliation: Department of Urology, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. horiuchi@med.teikyo-u.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Horiuchi
authors.affiliation: Department of Urology, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. kojat@med.teikyo-u.ac.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Koja
authors.affiliation: Department of Urology, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. santa-gary.0110@k.vodafone.ne.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Noguchi
authors.affiliation: Department of Urology, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. ssugiura@med.teikyo-u.ac.jp.
authors.forename: Shouichiro
authors.initials: S
authors.lastname: Sugiura
authors.affiliation: Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan. hsimoya@med.teikyo-u.ac.jp.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Shimoyama
authors.affiliation: Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan. toitoitoi_82@med.teikyo-u.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Noma
authors.affiliation: Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan. kkitamura@med.teikyo-u.ac.jp.
authors.forename: Kousuke
authors.initials: K
authors.lastname: Kitamura
authors.affiliation: Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan. china@med.teikyo-u.ac.jp.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: China
authors.affiliation: Department of Urology, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. shino.55.shino@gmail.com.
authors.forename: Shino
authors.initials: S
authors.lastname: Tokiwa
authors.affiliation: Department of Urology, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. keisukesaitoo@gmail.com.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Urology, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. mkimura@med.teikyo-u.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kimura
authors.affiliation: Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan. hisasue@med.teikyo-u.ac.jp.
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Hisasue
authors.affiliation: Department of Urology, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. ihisamit@med.teikyo-u.ac.jp.
authors.forename: Hisamitsu
authors.initials: H
authors.lastname: Ide
authors.affiliation: Department of Urology, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. muto@med.teikyo-u.ac.jp.
authors.forename: Satoru
authors.initials: S
authors.lastname: Muto
authors.affiliation: Department of Urology, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. y-raizo@med.teikyo-u.ac.jp.
authors.forename: Raizo
authors.initials: R
authors.lastname: Yamaguchi
authors.affiliation: Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan. shorie@med.teikyo-u.ac.jp.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Horie
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D002295:Carcinoma, Transitional Cell / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D016896:Treatment Outcome