Acute acalculous cholecystitis in systemic lupus erythematosus: a rare initial manifestation

Abstract

Acute acalculous cholecystitis is a very rare gastrointestinal manifestation in systemic lupus erythematosus and becomes rarer as an initial manifestation. There are only two cases reported. The authors report a 20-year-old black woman that presented acute acalculous cholecystitis revealed by abdominal computed tomography. During hospitalization, she was diagnosed systemic lupus erythematosus. Conservative treatment with antibiotics was performed with complete remission of the symptoms. Corticosteroid was started in ambulatory. Cholecystectomy has been the treatment of choice in acute acalculous cholecystitis as a complication of systemic lupus erythematosus. The patient responded well to conservative treatment, and surgery was not required. This case is unique in the way that corticosteroid was started in ambulatory care. We should not forget that the acute acalculous cholecystitis can be the initial presentation of systemic lupus erythematosus although its occurrence is very rare. Conservative treatment should be considered. Abdominal computed tomography was a determinant exam for better assessment of acute acalculous cholecystitis.

Acute acalculous cholecystitis in patients with systemic lupus erythematosus: A unique form of disease flare

“…We undertook a literature review by searching the key words of “systemic lupus erythematosus” and “acute acalculous cholecystitis” in PubMed from 1983 to 2016, and we found eight case reports. 3–10 As shown in Table 2, seven patients were female and one patient was male. The mean age was 29.3 years (range 10–61 years).…”

“…The deposition of immune complexes in blood vessel walls results in acute vasculitis, leading to ischemia and fibrosis of the target organ. 10 Positive anti-phospholipid antibodies may be found in patients with AAC that have evidence of thrombus. 8,12 Mesenteric inflammatory veno-occlusive disease (MIVOD) is another rare cause of AAC in SLE.…”

Acute Acalculous Cholecystitis as a Presenting Manifestation in Systemic Lupus Erythematosus

“…Endoscopic therapy with nasobiliary drainage is a third option for patients who cannot tolerate either surgery or cholecystostomy [5] . High-dose steroid therapy has been reported to be successful in a few cases and can be tried in selected patients, depending on general condition, disease severity and associated risk factors [1,2] . This case posed a diagnostic challenge.…”

“…SLE seldom presents as acute acalculous cholecystitis (AAC). Initial presentation of SLE as AAC is also rare: only four cases have been reported in the literature [1,2] . This is the first reported case of SLE manifested as AAC during the postpartum period.…”

Colecistite aguda alitiásica em paciente pediátrico previamente hígido: relato de caso

“…A CAA tem como fisiopatologia a estase biliar, que culmina com liberação de mediadores inflamatórios locais que causam isquemia e necrose da parede, favorecendo o crescimento bacteriano e causando inflamação local que culmina em dor localizada em hipocôndrio direito, náuseas e vômitos 1,3 . Além desses sintomas, pode ter como manifestações clínicas febre, distensão abdominal e menos frequentemente massa palpável ou icterícia 2,8 . A suspeição dessa patologia é pequena devido a sua baixa incidência.…”