高齢発症ループス膀胱炎の一例 A case of lupus cystitis in a 74-year-old woman

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  症例は74歳,女性.平成10年レイノー現象出現.平成14年抗核抗体陽性を指摘され当科初診.白血球減少,抗DNA抗体陽性,抗RNP抗体陽性を認めたが,活動性病変を伴わず経過観察していた.平成17年2月より頻尿,残尿感が出現し,同年11月より下痢,嘔気を認め,当院入院.腹部CT上,両側水腎症,著明な水尿管および膀胱壁肥厚を認め,膀胱鏡では肉柱形成を認め,生検では間質性膀胱炎の所見を得た.また下部内視鏡検査では結腸粘膜は浮腫状で,生検所見では粘膜下層に炎症細胞浸潤を認め,免疫染色で小血管壁にIgGの沈着を認めた.ループス膀胱炎で発症した全身性エリテマトーデス(SLE)と診断した.プレドニゾロン50 mg投与を開始したところ臨床所見の改善を認めた.本症例は,74歳と高齢発症のループス膀胱炎で,腸管粘膜の免疫染色で小血管壁にIgGの沈着を認め,消化管症状の原因疾患が,SLEによる自己免疫反応としての免疫複合体を介した腸炎であることを免疫組織学的に証明し得た貴重な症例と考えられた.1985年加藤らがループス膀胱炎を報告して以来,2007年までに本邦で46例のループス膀胱炎の報告がなされており,その臨床的特徴をまとめ本症例との比較検討を行った.<br>

  The patient was a 74-year-old woman. As the history of the present illness, Raynaud's phenomenon appeared in 1998, antinuclear antibody positivity was detected in 2002, and she visited our department for the first time. Leukopenia and positivity for anti-DNA and anti-RNP antibodies were present, but active lesions were not, and thus, course observation was selected. Pollakiuria and a sensation of residual urine appeared in February 2005, diarrhea and nausea developed in November, and she was admitted to our hospital. Abdominal CT detected bilateral hydronephrosis, marked hydroureter, and hypertrophy of the urinary bladder wall, cystoscopy detected trabeculation, and features of interstitial cystitis were noted on biopsy. Edematous colon mucosa was noted on lower endoscopy, submucosal inflammatory cell infiltration on biopsy, and IgG deposition in the small vascular wall on immunostaining. Systemic lupus erythematosus (SLE) that developed as lupus cystitis was diagnosed. The clinical findings were improved by 50 mg of prednisolone. Although she developed lupus cystitis at an elderly age of 74 years, IgG deposition in the small vascular wall was detected by immunostaining of the intestinal mucosa. It is a valuable case proved that causative disease of a digestive tract symptom was enterocolitis through an immune complex as autoimmune reaction by SLE immunohistologically. There are 46 cases of lupus cystitis in Japan by 2007 since Kato reported lupus cystitis in 1985. We summarize clinical features of 46 cases and discuss difference with this case.<br>

収録刊行物

  • 日本臨床免疫学会会誌 = Japanese journal of clinical immunology  

    日本臨床免疫学会会誌 = Japanese journal of clinical immunology 31(3), 183-189, 2008-06-30 

    The Japan Society for Clinical Immunology

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各種コード

  • NII論文ID(NAID)
    10021242762
  • NII書誌ID(NCID)
    AN00357971
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    09114300
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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