膀胱マラコプラキーの1例

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(We reported at the 287th session of the Tokyo regional meeting of the Japanese Urological Association) Malakoplakia of the urinary bladder, first named by von Hansemann in 1903, has become a well-defined gross pathologic entity. The disease is characterized by soft plaques which have given the lesion its name. We present here a case report of Malakoplakia of urinary bladder which was found in a 28-year-old woman with anamnesis of systemic lupus erythematodes. I. Clinical findings: K.S., 28-year-old woman. Family history: Parents died of apoplexia cerebri. Personal history: She was with appendectomy when 19 years old, was married at 26. She was first referred to us in April 1961 with erythema on the back of the hands as well as on both sides of the face in dark red butterfly shapes, systemic languor, a weak appetite, and a high fever (39℃). She was hospitalized for our dermatological treatment with diagnosis of "systemic lupus erythematodes". By means of steroid and antibiotic therapy, she made a favorable progress and was released from the hospital. She was hospitalized again on July 10, 1963 with a high fever of 39℃., shoulder pain, knee pain, headache, sore throat and spreading erythema on the face. She improved satisfactorily and was released on December 12 of the same year. Present History: She complained of "frequency, pain of urination" around January 10 this year (1964). She came to hospital for the consultation on January 13. Urinalysis at the first examination: Cloudy urine, Albumin test (++), Sugar (-), Urobilinogen normal. Sediment: Red blood cell (+), White blood cell (++), epithel (+), E. Coli (++). Cystoscopic finding at that time: Cystoscopic examination revealed general hyperamia and some bleeding points beneath the mucosa. Diagnosis was coligenic cystitis. With a medication of Furadantin (300 mg/day) for five days the patient made a favorable turn. Again the patient complained of cloudy urine, pain of urination, burning and frequency around February 10, and therefore sought consultation. Urinalysis at that time: Cloudy urine, Albumin test (+), Sugar (-). Sediment: White blood cell (++), epithel (+), bacterium (-), Culture: E. Coli (++). Only Kanamycin was effective in sensitivity test. Culture of tubercle bacillus negative. Examination of the blood disclosed 11.2g per cent hemoglobin, 3,560,000 red blood cells and 5,300 white blood cells, with a differential count of 42% segmented neutrophils, 7% nonsegmented neutrophils, 1% eosinophils, 50% lymphocytes. The blood NPN ,was 34.0mg/dl. Creatinine was 0.95mg/dl. Serum total proteins was 9.2g/dl. Specific gravity: 1.032 and included a serum Na of 134m Eq/liter; cl: 105.5m Eq/liter, K: 10.6mg/dl. Serum protein fraction revealed the following: albumin 27.0%, alpha-1-globulin 11.3%, alpha-2-globutin 13.1%, beta globulin 14.4%, gamma globulin 34.1%, ASLO determination gives 120 units. CRP test was negative. The serologic test for syphilis was negative in the blood. IP showed bifid pelvis and ureter of right side. Examination of separated renal urine was not pathologic. Cystoscopic finding at the second examination: (Fig. 1) The whole of the mucous membrane of the bladder with the exception of the trigonum vesicae was strewn with canary yellow plaques, which varied in size from rounded or ovals. The central part was depressed. Around the edge of the plaque there was congested halo and there was no ulceration. The mucous membrane apart from the plaques was healthy and the ureteric orifices were normal. It was decided that this finding was the case of Malakoplakia of the bladder, and so biopsy was applied to it. II. Pathohistological findings (Fig. 2, 3, 4): "Granulomatous and exudative Cystitis."
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膀胱マラコプラキーの1例

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