Acute Lupus Peritonitis during Treatment ofLupus Nephritis: Successful Treatment with Methylprednisolone Pulse Therapy

Uzu, Takashi; Chikamori, Yasuhiro; Yamato, Masayuki; Iwatani, Hirotsugu; Kakihara, Masahiro; Yamauchi, Atsushi

doi:10.1159/000045846

“…Acute lupus peritonitis occurs with gastrointestinal symptoms such as abdominal pain, vomiting, and diarrhea, and treatment with corticosteroids often produces rapid improvement [7,8]. On the other hand, chronic lupus peritonitis is painless and responds poorly to corticosteroid therapy [1][2][3][4].…”

Section: Discussionmentioning

confidence: 99%

A patient with systemic lupus erythematosus who developed massive small intestinal hemorrhaging during treatment for chronic lupus peritonitis

Kawashiri

¹

,

Nishino

²

,

Sueyoshi

³

et al. 2011

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A 50-year-old Japanese woman, a patient with systemic lupus erythematosus (SLE) complicated with chronic lupus peritonitis, developed massive small intestinal hemorrhaging. She was treated with intravenous pulse of methylprednisolone, intravenous pulse of cyclophosphamide (IVCY), and immunoabsorption, but the peritonitis was refractory to these treatments. Subsequently, she was treated with oral corticosteroid and tacrolimus, and received IVCY monthly, but she developed massive small intestinal hemorrhaging 1 year after. Abdominal angiography detected multiple bleeding sites from the jejunal and ileal arteries. After transarterial embolization treatment, the melena disappeared. The pathology of this case appeared to be lupus mesenteric vasculitis.

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“…Peritoneal effusion caused by pericarditis, heart failure, nephrotic syndromeand/or liver disease were reported to exist in 6-45% of the patient group (19). Acute lupus peritonitis, which was related to vasculitis in the perito- generalized lupus flare and treatment using steroids produced rapid improvement without any aftereffects of the disease (20)(21)(22). On the other hand, chronic painless peritonitis, described as chronic lupus peritonitis (16), responded poorly to corticosteroid therapy (5-8, 10, ll, 14-18).…”

Section: Discussionmentioning

confidence: 99%

Chronic Lupus Peritonitis with Massive Ascites at Elderly Onset: Case Report and Review of the Literature.

Itoh

¹

,

Nanamiya

²

,

Inoue

³

et al. 2002

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A 77-year-old Japanese womanwith massive painless ascites caused by chronic lupus peritonitis is reported. Peritoneal effusion had been resistant to the administration of steroids during the whole treatment period. It was characteristic that the titers of anti-DNA antibodies and the level of immunecomplex were elevated in the peritoneal fluid with suppressed levels of complements in ascites, although serum immunological markers reflecting the activity of SLE presented improvement after initiation of the treatment. Fifteen patients with chronic lupus peritonitis were reported previously. Wereviewed the literature and suggest that chronic lupus peritonitis at elderly onset may demonstrate a poor response to the glucocorticoid therapy because of persistent inflammation in the peritoneum and the presence of impaired vascular circulation in addition to immunological mechanisms.

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“…Acute lupus peritonitis occurs with gastrointestinal symptoms such as abdominal pain, vomiting, and diarrhea, and treatment with corticosteroids often produces rapid improvement [7,8]. On the other hand, chronic lupus peritonitis is painless and responds poorly to corticosteroid therapy [1][2][3][4].…”

Section: Discussionmentioning

confidence: 99%

A patient with systemic lupus erythematosus who developed massive small intestinal hemorrhaging during treatment for chronic lupus peritonitis

Kawashiri¹,

Nishino²,

Sueyoshi³

et al. 2012

Modern Rheumatology

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A 50-year-old Japanese woman, a patient with systemic lupus erythematosus (SLE) complicated with chronic lupus peritonitis, developed massive small intestinal hemorrhaging. She was treated with intravenous pulse of methylprednisolone, intravenous pulse of cyclophosphamide (IVCY), and immunoabsorption, but the peritonitis was refractory to these treatments. Subsequently, she was treated with oral corticosteroid and tacrolimus, and received IVCY monthly, but she developed massive small intestinal hemorrhaging 1 year after. Abdominal angiography detected multiple bleeding sites from the jejunal and ileal arteries. After transarterial embolization treatment, the melena disappeared. The pathology of this case appeared to be lupus mesenteric vasculitis.

show abstract

Acute Lupus Peritonitis during Treatment ofLupus Nephritis: Successful Treatment with Methylprednisolone Pulse Therapy

Cited by 7 publications

References 5 publications

A patient with systemic lupus erythematosus who developed massive small intestinal hemorrhaging during treatment for chronic lupus peritonitis

A patient with systemic lupus erythematosus who developed massive small intestinal hemorrhaging during treatment for chronic lupus peritonitis

Chronic Lupus Peritonitis with Massive Ascites at Elderly Onset: Case Report and Review of the Literature.

A patient with systemic lupus erythematosus who developed massive small intestinal hemorrhaging during treatment for chronic lupus peritonitis

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