A Case of Systemic Lupus Erythematosus Presenting with an Acute Abdomen: Successful Treatment with Steroid

Abdominal pain continues to pose diagnostic challenges for emergency clinicians. A 56-year-old Japanese woman was referred to our hospital due to severe abdominal pain which presented as occasional epigastric pain five months before and intermittent abdominal pain. She had a past history of ileus twice, for both of which laparotomy was performed without an alimentary tract resection. The wall thickening with marked three-wall structure from terminal ileum to sigmoid colon was seen and bladder wall was irregularly thick and enhanced irregularly. Among the differential diagnosis of the acute abdomen, autoimmune diseases were suspected, especially lupus erythematosus and Henoch-Schönlein purpura. On the second day of admission, abdominal pain worsened. The results of examinations of antinuclear antibody, anti-double-stranded DNA antibody, ANCA, and the complements were not obtained at that time; however, we started 1-g steroid pulse treatment for three days with success. With the results obtained later, the patient was given a diagnosis of probable systemic lupus erythematosus (SLE). The present case shows that SLE can present with acute abdomen and should be included in the wide range of the differential diagnosis of acute abdomen.

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Systemic lupus erythematosus or lupus-like syndrome in patients with HIV infection: clinical case review

Clinical review for general practice ◽

10.47407/kr2021.2.1.00029 ◽

2021 ◽

Vol 2 (1) ◽

pp. 22-27

Author(s):

Margarita A. Gromova ◽

Keyword(s):

Systemic Lupus Erythematosus ◽

Differential Diagnosis ◽

Hiv Infection ◽

Lupus Erythematosus ◽

Connective Tissue Diseases ◽

Clinical Manifestations ◽

High Dose ◽

Case Review ◽

Systemic Lupus ◽

Wide Range

Background. Due to multi-organ lesions and a wide range of clinical manifestations, human immunodeficiency virus (HIV infection) resembles systemic connective tissue diseases, particularly systemic lupus erythematosus (SLE). Similarity of immune disorders in patients with HIV infection and SLE may lead to misdiagnosis resulting in wrong tactics of treatment (prescribing immunosuppressive therapy instead of high-dose antiretroviral therapy). Aim. To report the HIV infection and SLE differential diagnosis challenges. Results. By January 2021, the analysis of national literature revealed two cases of HIV infection in young women, initially misdiagnosed with suspected SLE. In addition to two patients described in literature, one more female patient with SLE manifestations combined with advanced stage of HIV infection was examined. Conclusion. HIV and SLE differential diagnosis is the ultimate challenge for clinicians. Physicians should be especially apprehensive about HIV infection when making the diagnosis of SLE. SLE therapy in patients with HIV infection should be appointed according to strict indications.

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A rare case of lupus-related gastrointestinal vasculitis presenting as rectal gangrene

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz128 ◽

2019 ◽

Vol 2019 (4) ◽

Cited By ~ 1

Author(s):

Yi Liang ◽

Angelina Di Re ◽

Toufic El Khoury

Keyword(s):

Systemic Lupus Erythematosus ◽

Abdominal Pain ◽

Acute Abdomen ◽

Case Studies ◽

Lupus Erythematosus ◽

Rare Case ◽

Rare Condition ◽

Free Fluid ◽

Systemic Lupus ◽

Current Case

Abstract Systemic lupus erythematosus (SLE) related gastrointestinal vasculitis is a rare condition limited to case studies within the literature however, no cases of rectal gangrene and perforation have been previously described. A 32-year-old male presented with abdominal pain, vomiting and fevers. CT demonstrated free gas and free fluid around the rectum indicative of a perforation. He proceeded to urgent laparotomy, confirming a diagnosis of rectal infarction and perforation. Uniquely, the involved segment of gangrene extended from the rectosigmoid to the anorectal junction. A Hartmanns procedure was performed. Histopathology confirmed underlying stenosis of the rectal arteries secondary to chronic vasculitis related to the affected areas. The current case is a unique presentation of SLE-related vasculitis. It highlights the need to judiciously investigate SLE patients presenting with surgical acute abdomen.

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Corticosteroid associated lupus pancreatitis

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.66.10.1414 ◽

2020 ◽

Vol 66 (10) ◽

pp. 1414-1416

Author(s):

Semra Demirli Atıcı ◽

Ömer Engin ◽

Göksever Akpınar ◽

Cem Tuğmen

Keyword(s):

Systemic Lupus Erythematosus ◽

Acute Pancreatitis ◽

Abdominal Pain ◽

Acute Abdomen ◽

Steroid Therapy ◽

Lupus Erythematosus ◽

Free Fluid ◽

Systemic Lupus ◽

Pulse Steroid Therapy ◽

Pulse Steroid

SUMMARY The relationship between acute pancreatitis and the administration of glucocorticoids is unclear because most reported cases have been diagnosed with systemic vascular diseases, such as systemic lupus erythematosus, which may be responsible for pancreatitis. A 22-year-old woman with eye involvement of a newly diagnosed systemic lupus erythematosus was admitted to our hospital. Pulse intravenous methylprednisolone therapy was given at 1mg/kg day for 3 days, and oral prednisolone at 40 mg/day thereafter. During pulse steroid therapy, she had abdominal pain, back pain, distention, nausea, and vomiting. Her physical examination was compatible with acute abdomen and peritonitis. Abdomen Computerized Tomography scan revealed diffuse liquid perihepatic and perisplenic area with heterogeneity around the mesentery. Due to the symptoms of acute abdomen, explorative laparotomy was performed. There was diffuse free fluid in the abdomen and edematous changes were observed around the pancreas. Amylase and lipase from intraabdominal fluid were studied and found to be high. The postoperative prednol dose was reduced carefully. On the sixth postoperative day, the drain was removed, and the patient was discharged without any problem. Physicians should keep in mind that acute pancreatitis may also be a cause of differential diagnosis of newly developed abdominal pain in patients receiving pulse steroid therapy with a normal level of serum amylase and lipase.

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Reply to “Calcified Splenic Lesions: Silicosis and Systemic Lupus Erythematosus Should Be Considered in the Differential Diagnosis”

American Journal of Roentgenology ◽

10.2214/ajr.20.23876 ◽

2020 ◽

Vol 215 (6) ◽

pp. W64-W64

Author(s):

Nikita Consul ◽

Sidra Javed-Tayyab ◽

Khaled M. Elsayes

Keyword(s):

Systemic Lupus Erythematosus ◽

Differential Diagnosis ◽

Lupus Erythematosus ◽

Systemic Lupus

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Autoantibodies in Neuropsychiatric Systemic Lupus Erythematosus (NPSLE): Can They Be Used as Biomarkers for the Differential Diagnosis of This Disease?

Clinical Reviews in Allergy & Immunology ◽

10.1007/s12016-021-08865-2 ◽

2021 ◽

Author(s):

Elias Manca

Keyword(s):

Systemic Lupus Erythematosus ◽

Central Nervous System ◽

Nervous System ◽

Differential Diagnosis ◽

Human Body ◽

Lupus Erythematosus ◽

Neuropsychiatric Symptoms ◽

Systemic Lupus ◽

Neuropsychiatric Systemic Lupus Erythematosus ◽

The Central Nervous System

AbstractSystemic lupus erythematosus is a complex immunological disease where both environmental factors and genetic predisposition lead to the dysregulation of important immune mechanisms. Eventually, the combination of these factors leads to the production of self-reactive antibodies that can target any organ or tissue of the human body. Autoantibodies can form immune complexes responsible for both the organ damage and the most severe complications. Involvement of the central nervous system defines a subcategory of the disease, generally known with the denomination of neuropsychiatric systemic lupus erythematosus. Neuropsychiatric symptoms can range from relatively mild manifestations, such as headache, to more severe complications, such as psychosis. The evaluation of the presence of the autoantibodies in the serum of these patients is the most helpful diagnostic tool for the assessment of the disease. The scientific progresses achieved in the last decades helped researchers and physicians to discover some of autoepitopes targeted by the autoantibodies, although the majority of them have not been identified yet. Additionally, the central nervous system is full of epitopes that cannot be found elsewhere in the human body, for this reason, autoantibodies that selectively target these epitopes might be used for the differential diagnosis between patients with and without the neuropsychiatric symptoms. In this review, the most relevant data is reported with regard to mechanisms implicated in the production of autoantibodies and the most important autoantibodies found among patients with systemic lupus erythematosus with and without the neuropsychiatric manifestations.

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SYSTEMIC LUPUS ERYTHEMATOSUS AND ABDOMINAL PAIN

Rheumatology ◽

10.1093/rheumatology/22.3.172 ◽

1983 ◽

Vol 22 (3) ◽

pp. 172-175 ◽

Cited By ~ 16

Author(s):

P.J. PROUSE ◽

E.M. THOMPSON ◽

J.M. GUMPEL

Keyword(s):

Systemic Lupus Erythematosus ◽

Abdominal Pain ◽

Lupus Erythematosus ◽

Systemic Lupus

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PSEUDOTUMOR CEREBRI AS A DIFFERENTIAL DIAGNOSIS FOR VISION LOSS IN SYSTEMIC LUPUS ERYTHEMATOSUS: CASE REPORT

10.5151/sbr2019-215 ◽

2019 ◽

Author(s):

MARCO FELIPE MACÊDO ALVES ◽

CAIO FELIPE FARIAS BARROS ◽

JARDELINA BRENA ROCHA LEITE ◽

MARINA ACEVEDO ZARZAR DE MELO ◽

PEDRO JOSÉ GALVÃO FREIRE ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Differential Diagnosis ◽

Case Report ◽

Lupus Erythematosus ◽

Vision Loss ◽

Pseudotumor Cerebri ◽

Systemic Lupus ◽

Systemic Lupus Erythematosus Case

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Liver involvement in patients with systemic lupus erythematosus

Rheumatology Science and Practice ◽

10.47360/1995-4484-2021-164-172 ◽

2021 ◽

Vol 59 (2) ◽

pp. 164-172

Author(s):

A. P. Panova ◽

V. G. Avdeev ◽

T. N. Krasnova ◽

T. P. Rozina ◽

E. P. Pavlikova ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Differential Diagnosis ◽

Lupus Erythematosus ◽

Liver Diseases ◽

Liver Enzymes ◽

Liver Steatosis ◽

Liver Involvement ◽

Systemic Lupus ◽

Viral Hepatitis C ◽

Lupus Hepatitis

Liver involvement in systemic lupus erythematosus is common and in most cases clinical course is asymptomatic, that makes diagnosis difficult. Determination of the cause of the liver involvement is important to select treatment and to evaluate the prognosis of the disease.The aim of the research was to characterize the clinical features of liver involvement in patients with systemic lupus erythematosus and identify the most significant clinical and laboratory parameters for the differential diagnosis of lupus hepatitis.Materials and methods. The study included 313 patients with systemic lupus erythematosus observed in the E.M. Tareev Clinic of Rheumatology, Internal Medicine and Occupational Diseases of I.M. Sechenov First Moscow State Medical University (Sechenov University) in the period from 2001 to 2019. The verification of diagnosis of systemic lupus erythematosus was based on the criteria of the American College of Rheumatology (1997). Patients examination included complete blood count, biochemical and immunological blood tests and an abdominal ultrasonography. In 13 cases hepatic autoantibodies (ASMA, anti-LKM-1, LC-1, SLA-LP, AMA-M2) were analyzed, in 4 – magnetic resonance cholangiopancreatography and in 6 – liver biopsy were made.Results. Liver involvement were represented by an increase of liver enzymes in 58 (18.5%) cases. Chronic viral hepatitis C was diagnosed in 4 (1.3%) patients. Drug-induced hepatitis was found in 17 (5.4%) patients. Autoimmune liver diseases occured in 2 (0.6%) patients. In 2 (0.6%) patients, liver damage was associated with thrombotic microangiopathy (atypical hemolytic uremic syndrome, hereditary thrombophilia). In 15 (4.8%) cases, the most likely diagnosis was NAFLD. Lupus hepatitis was the most likely cause in 18 (5.7%) patients. Differential diagnosis in cases of liver involvement in patients with systemic lupus erythematosus requires assessment of risk factors for various liver diseases, age of the patients, level of liver enzymes, lupus activity, ultrasound signs of liver steatosis and secondary antiphospholipid syndrome.Determining the cause of the liver involvement for the patients with the systemic lupus erythematosus allows establishing better treatment tactic and improvement of the prognosis.

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SPECIFIC MARKERS OF NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS WITH MENTAL DISORDERS – REVIEW OF THE LITERATURE

Wiadomości Lekarskie ◽

10.36740/wlek201907124 ◽

2019 ◽

Vol 72 (7) ◽

pp. 1359-1363

Author(s):

Marcin Zarzycki ◽

Magdalena Flaga-Łuczkiewicz ◽

Joanna Czuwara ◽

Lidia Rudnicka

Keyword(s):

Systemic Lupus Erythematosus ◽

Psychiatric Disorders ◽

Lupus Erythematosus ◽

Neuropsychiatric Disorders ◽

Systemic Lupus ◽

Medical Specialties ◽

Potential Association ◽

Neuropsychiatric Sle ◽

Neuropsychiatric Diseases ◽

Wide Range

Systemic lupus erythematosus (SLE) is a chronic multiorgan autoimmune disease belonging to spectrum of interest of many medical specialties. Wide range of patients 14−75% with SLE suffers from neuropsychiatric disorders. The problematic diagnosis of neuropsychiatric SLE has generated many studies focusing on etiology of the disease with the presence of specific autoantibodies, abnormalities which can be detected by imaging examinations or correlation with catecholamine levels. The aim of this review paper is to discuss the frequency of neuropsychiatric disturbances in patients with SLE and their potential association with immunological abnormalities and specific disease markers. So far published literature regarding this topic indicates the usefulness of autoantibodies specificity. The use of the specific antibodies may be helpful in targeting diagnostics towards psychiatric disorders, especially depressive ones. Imaging scanning techniques such as computed tomography (CT) have limited value in psychiatric disorders diagnosis but can be useful in neurological symptoms and complains. Therapeutic use of systemic glucocorticosteroids due to anti-inflammatory properties with multidirectional action, may also significantly influence the course of neuropsychiatric diseases, especially in patients with SLE. Awareness of the morbidity of neuropsychiatric disorders and the possibilities of their diagnosis are important in the management of patients with systemic lupus erythematosus, which significantly affects the quality of life of patients, treatment efficacy and psyche.

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