Massive and painful ascites as a presenting manifestation of systemic lupus erythematosus flare: a case report and literature review

Zhou, Lei; Sun, Chen; Chen, Wen Li; Zhang, Heng; Wang, Ping; Wu, Jie

doi:10.4067/s0034-98872014000200016

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…Serositis is one of the major organ involvements and observed in 10%-30% of lupus patients (Man and Mok 2005;Al Arfaj and Khalil 2009). Pleural and pericardial involvements are common; however, peritoneal serositis, which is also called lupus peritonitis, is rare (Man and Mok 2005;Prasad et al 2012;Zhou et al 2014).…”

Section: Introductionmentioning

confidence: 99%

Chronic Lupus Peritonitis Is Characterized by the Ascites with a Large Content of Interleukin-6

Watanabe

Fujii

Kamogawa

et al. 2015

Tohoku J. Exp. Med.

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Systemic lupus erythematosus (SLE) is an autoimmune disease and can cause multi-organ damage. Peritoneal involvement, also called lupus peritonitis, is a rare but sometimes fatal manifestation. Deposition of immune complexes consisting of immunoglobulin G and complement is considered to be involved in the pathogenesis of lupus peritonitis; however, it remains unknown whether inflammatory cytokines contribute to the pathology of this manifestation. Here we present two patients with treatment-resistant lupus peritonitis: a 37-year-old woman with a 26-year history of SLE who had been treated with prednisolone and cyclophosphamide followed by azathioprine and a 65-year-old woman with a 33-year history of SLE who had been treated with prednisolone alone. Both patients were admitted to our department because of abdominal distention. Computed tomography scans showed massive ascites. Ascitic fluid examinations of both patients showed leukocytosis with no evidence of malignancy or infection. After eliminating other causes for ascites, they were diagnosed with lupus peritonitis. Despite the intensified immunosuppressive therapy, they died of uncontrolled peritonitis several months after admission. Examinations of the ascites at admission also revealed a large content of interleukin (IL)-6, compared with other inflammatory cytokines, IL-1β and tumor necrosis factor-α. In fact, the ascitic IL-6 levels of these two patients were 12,389 pg/mL and 5,486 pg/mL, much higher than their serum IL-6 levels of 36 pg/mL and 140 pg/mL, respectively. We therefore suggest that IL-6 may contribute to the pathogenesis of lupus peritonitis and that the inhibition of IL-6 signaling may provide a novel therapeutic strategy for lupus peritonitis.

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Section: Introductionmentioning

confidence: 99%

Chronic Lupus Peritonitis Is Characterized by the Ascites with a Large Content of Interleukin-6

Watanabe

Fujii

Kamogawa

et al. 2015

Tohoku J. Exp. Med.

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“…Serositis is commonly seen in patients with connective tissue disease (CTD) such as systemic lupus erythematosus (SLE), where there is no macroscopic lesion in the peritoneal cavity. Lei Zhou et al reported a patient who had massive and painful ascites as a prominent manifestation of SLE, in the absence of other well-recognized clinical features of SLE and the common causes of ascites [ 12 ]. Crohn's disease is a granulomatous inflammatory bowel disease which presents differently according to the lesion location, type, and complications.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Different Accesses Single Orifice Percutaneous Endoscopic Surgery in Diagnosis of Ascites of Unknown Origin: A Retrospective Study

Guo

et al. 2022

Journal of Oncology

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Background. Ascites is a common clinical finding caused by many different diseases, so we developed a technique termed single orifice percutaneous endoscopic surgery (SOPES) which can access peritoneal cavity through the contralateral McBurney’s point or umbilicus to seek the underlying causes. In this study, we describe the initial clinical experience of SOPES and compare the application of two accesses. Methods. This is a retrospective study performed between 2007 and 2018. Patients with ascites of unknown origin who underwent these two kinds of SOPES were included. Main outcomes were measured by diagnostic accuracy, complication rate, procedure time, time till stitches removal, length of hospital stay, and hospital cost. Results. 148 patients successfully undergone SOPES via the contralateral McBurney’s point (IM group, n = 70 ) or the umbilicus (UM group, n = 78 ). 63 patients in the IM group and 71 patients in the UM group reached clear diagnosis (90.0% vs. 91.0%, p = 0.831 ). The overall complication rate was 5.4%, while the UM group was higher than the IM group (10.3% vs. 0%, p = 0.017 ). All complications were resolved after medical treatment, and no mortality resulted from this procedure. The procedure time and the time until stitches removal in the UM group were longer than that in the IM group. There were no significant differences in length of hospital stay and hospital cost between the two groups. Conclusions. SOPES, which combines the strength of minimally invasive single orifice incision and flexible angles of examination and instrumentation, is a newly developed flexible endoscopic surgical modality that provides new important clinical valuable in evaluation of ascites of unknown origin. Moreover, SOPES via the contralateral McBurney’s point was safer than the umbilicus approach.

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“…Systemic lupus erythematosus (SLE) is a chronic, multi-organ autoimmune disease. It frequently involves the gastrointestinal system and serosal tissues [ 1 ], while peritoneal involvement is very rarely described [ 2 ]. The symptoms of SLE are usually vague and non-specific, contributing to the challenge of diagnosing it in the emergency department (ED).…”

Section: Introductionmentioning

confidence: 99%

When a Rapid Accurate Diagnosis Changes Therapeutic Approach: Recognizing Acute Abdominal Pain with Ascites as a Possible Presentation of Systemic Lupus Erythematosus

et al. 2022

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Systemic lupus erythematosus (SLE) is a chronic, multi-organ autoimmune disease which rarely presents with peritoneal involvement. As such, its diagnosis in the emergency department (ED) based on a clinical presentation of gastrointestinal symptoms is extremely challenging. Yet, reaching such a diagnosis in the ED is crucial for avoiding unnecessary surgical intervention and initiating early glucocorticoid therapy to maximise patient outcomes. Here, we report a case of newly diagnosed SLE in a 28-year-old lady who presented atypically and unusually with abdominal pain and ascites. She required extensive but methodical investigations, and was eventually diagnosed with lupus mesenteric vasculitis with underlying newly diagnosed SLE in the ED. The patient was promptly treated with methylprednisolone resulting in marked clinical improvement. Emergency physicians should be mindful of abdominal pain with ascites as an extremely rare but important clinical presentation of SLE. Early diagnosis and commencement of glucocorticoid therapy in these patients are crucial in halting disease progression and averting the need for surgical intervention.

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Massive and painful ascites as a presenting manifestation of systemic lupus erythematosus flare: a case report and literature review

Abstract: Lupus peritonitis (LP

Cited by 7 publications

References 18 publications

Chronic Lupus Peritonitis Is Characterized by the Ascites with a Large Content of Interleukin-6

Chronic Lupus Peritonitis Is Characterized by the Ascites with a Large Content of Interleukin-6

Comparison of Two Different Accesses Single Orifice Percutaneous Endoscopic Surgery in Diagnosis of Ascites of Unknown Origin: A Retrospective Study

When a Rapid Accurate Diagnosis Changes Therapeutic Approach: Recognizing Acute Abdominal Pain with Ascites as a Possible Presentation of Systemic Lupus Erythematosus

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