scholarly journals Corticosteroid associated lupus pancreatitis

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.

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

2019 ◽  
Vol 2019 (4) ◽  
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.

Invasive aspergillosis in patients with systemic lupus erythematosus: a retrospective study on clinical characteristics and risk factors for mortality

Lupus ◽  
2018 ◽  
Vol 27 (12) ◽  
pp. 1944-1952 ◽  
Author(s):  
ML Hung ◽  
HT Liao ◽  
WS Chen ◽  
MH Chen ◽  
CC Lai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Invasive Aspergillosis ◽  
Steroid Therapy ◽  
Mortality Risk ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Pulse Steroid Therapy ◽  
Concurrent Infections ◽  
Pulse Steroid

Objective The objective of this paper is to analyze the clinical features, outcomes, mortality risk factors, and all-cause mortalities of invasive aspergillosis (IA) in patients with systemic lupus erythematosus (SLE). Methods Medical records were reviewed to identify SLE patients with IA from January 2006 to June 2017, at Taipei Veterans General Hospital, Taiwan. A total of 6714 SLE patients were included. Clinical/laboratory parameters and treatment outcomes were analyzed. Results Four patients (19.0%) had definite and 17 had probable (81.0%) IA. Seven patients (33.3%) survived and 14 died (66.7%). Concurrently, there were 19 pneumonias (90.5%), 17 cases of other infections (81.0%), eight bacteremia (38.1%), nine cytomegalovirus (CMV, 42.7%) and six Candida (28.6%) infections. In all 55 blood cultures, 38 (69.1%) yielded gram-negative bacilli, of which carbapenem-resistant A. baumannii accounted for eight (21.1%); 17 (30.9%) yielded gram-positive cocci, of which methicillin-resistant S. aureus accounted for six (35.3%); and vancomycin-resistant Enterococcus accounted for four (23.5%). Daily steroid dose ≥ 20 mg (hazard ratio (HR) 2.00), recent pulse steroid therapy (HR 2.80), azathioprine (HR 2.00), rituximab (HR 2.00), plasmapheresis (HR 2.00), acute respiratory distress syndrome (HR 2.00), concurrent infections (HR 5.667) and CMV viremia (HR 1.75) were higher in the fatality group. All p values were less than 0.05. Septic shock ( n = 7, 50% in the fatality group) is the most common cause of mortality. Conclusions High daily steroid dosing, recent pulse steroid therapy, azathioprine, rituximab, concurrent infections, and CMV viremia were mortality risk factors for IA in SLE.

Systemic lupus erythematosus-related acute pancreatitis

Lupus ◽  
2020 ◽  
Vol 30 (1) ◽  
pp. 5-14
Author(s):  
Alina Dima ◽  
Daniel Vasile Balaban ◽  
Ciprian Jurcut ◽  
Mariana Jinga
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Plasma Exchange ◽  
Lupus Erythematosus ◽  
High Dose ◽  
Systemic Lupus ◽  
Serum Lipase ◽  
Autoimmune Pathology ◽  
Short Disease Duration

Introduction Systemic lupus erythematosus (SLE) is a complex autoimmune pathology that can involve any organ. Lupus-related acute pancreatitis (AP) is, together with lupus mesenteric vasculitis, an important cause of SLE-induced acute abdominal pain. Methods A literature search was conducted using the terms “Pancreatitis” and “Lupus Erythematosus, Systemic” on PubMed/Medline and Web of Science from January 2007 to January 2020. Clinical characteristics, diagnostic approach, and treatment principles in SLE-related AP are presented in this review. Results Mainly retrospective reports were identified. The reported incidence of SLE-associated AP ranges from 0.9 to more than 5% of patients. A total of 264 SLE patients were found in the selected research, with a net female predominance (sex ratio 9:1) and mean age of 31.4 years. Abdominal pain was virtually present in all cases. AP occurrence was more frequent in SLE patients with short disease duration, high activity scores, and multiorgan involvement. The AP definition was based on currently available guidelines and after exclusion of any other known causes (including iatrogenic, i.e. drugs), a diagnosis of “idiopathic” SLE-related AP might be sustained. Management is difficult, as there is no standardized therapeutic approach. Of note, glucocorticoid use remains still controversial as, especially for high doses, subsequent pancreatic injury may occur. Monitoring serum lipase levels after high dose steroids might be considered. One study reported beneficial prognostic effect of plasma exchange. Moreover, AP in SLE might raise awareness about macrophage activation syndrome association. Mortality up to one third of AP cases in SLE was reported. Conclusion The SLE-related AP is a rare, but severe, life-threatening complication. Corticosteroids must be used with caution. Plasma exchange could be considered in selected cases.

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

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Haruka Fukatsu ◽  
Seisuke Ota ◽  
Koichi Sugiyama ◽  
Akinori Kasahara ◽  
Tadashi Matsumura
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Acute Abdomen ◽  
Lupus Erythematosus ◽  
Bladder Wall ◽  
Wall Structure ◽  
Wall Thickening ◽  
Systemic Lupus ◽  
Wide Range

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.

SYSTEMIC LUPUS ERYTHEMATOSUS AND ABDOMINAL PAIN

Rheumatology ◽  
1983 ◽  
Vol 22 (3) ◽  
pp. 172-175 ◽  
Author(s):  
P.J. PROUSE ◽  
E.M. THOMPSON ◽  
J.M. GUMPEL
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Abdominal Pain ◽  
Lupus Erythematosus ◽  
Systemic Lupus

Lupus Enteritis, a Severe and Potentially Fatal Complication of Systemic Lupus Erythematosus

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S64-S64 ◽  
Author(s):  
Hany Meawad ◽  
Andrew Kobalka ◽  
Yaseen Alastal ◽  
Brooke Koltz
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Abdominal Pain ◽  
Lupus Erythematosus ◽  
Clinical Symptoms ◽  
Meckel’S Diverticulum ◽  
Severe Abdominal Pain ◽  
Meckel's Diverticulum ◽  
Systemic Lupus ◽  
Gi Symptoms ◽  
Lupus Enteritis

Abstract Objectives Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that can show wide manifestations in many organs. The gastrointestinal tract (GI) is commonly affected in SLE; symptoms are often related to the side effect of medications or to infections. One rare GI complication of SLE is lupus enteritis, a complex of manifestations including intestinal vasculitis and enteric ischemia, which presents with vague symptoms of severe abdominal pain, nausea, vomiting, and diarrhea. Methods We present the case of a 25-year-old female who was admitted to the hospital with complaints of abdominal pain, vomiting, diarrhea, and a history of SLE. Complicating the patient’s clinical picture and diagnosis was gastrointestinal bleeding requiring multiple blood product transfusions secondary to bleeding Meckel’s diverticulum, lupus flare, and positive stool culture for campylobacter antigen. Repeated upper and lower GI endoscopies with biopsy failed to identify the exact cause of bleeding and GI symptoms; the patient underwent exploratory laparotomy with right hemicolectomy to control bleeding. Microscopic examination revealed marked small vessel acute vasculitis consistent with lupus enteritis, ischemic enteritis, and Meckel’s diverticulum with gastric heterotopia. Results Our patient was subsequently aggressively treated; however, she developed further associated complications and died. Conclusion The pathologic diagnosis of lupus enteritis is challenging due to the nonspecific clinical symptoms and paucity of pathologic findings on most biopsy specimens. Lupus enteritis must be considered in the differential diagnosis of severe abdominal pain in lupus patients to aid in early diagnosis and treatment as this condition could be severe and potentially fatal.

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