J Korean Rheum Assoc.  2004 Sep;11(3):286-291.

A Case of Bladder Cancer in a Patient with Systemic Lupus Erythematosus Treated with Oral Cyclophosphamide

• Kim KJ
• Kim WT
• Kim SY
• Hong JH
• Kim HR
• Yoon CH
• Lee SH
• Park SH
• Kim HY

Abstract

Cyclophosphamide, a cytotoxic alkylating agent, is widely used in various benign diseases like systemic lupus erythematosus (SLE), Wegener's granulomatosis, rheumatoid arthritis, nephrotic syndrome as well as in malignancies and organ transplantation. Cyclophosphamide is metabolized in the liver to various chlormethine metabolites and acrolein, which mediates the toxic effect to the urothelium and can cause hemorrhagic cystitis, bladder fibrosis, and has also been associated with urothelial malignancies including bladder cancer. It is known that SLE is not associated with an increased risk for the development of most of the solid tumors. But it has been suggested that the risk of the bladder cancer increases in patients with benign diseases such as SLE treated by cyclophosphamide. There are only very few reports of cyclophosphamide-induced bladder cancer in SLE so far. We report a case of a patient who developed bladder cancer 13 years after cyclophosphamide was given as therapy for SLE. This case shows that careful observation and urologic evaluation is undoubtedly important for patients treated with cyclophosphamide.

Keyword

Cyclophosphamide; Systemic lupus erythematosus; Bladder cancer

MeSH Terms

Acrolein
Arthritis, Rheumatoid
Cyclophosphamide*
Cystitis
Fibrosis
Humans
Liver
Lupus Erythematosus, Systemic*
Mechlorethamine
Nephrotic Syndrome
Organ Transplantation
Transplants
Urinary Bladder Neoplasms*
Urinary Bladder*
Urothelium
Wegener Granulomatosis
Acrolein
Cyclophosphamide
Mechlorethamine