Massive ascites as a presenting feature of lupus

Prasad, Shiva; Lawrence, Able; Aggarwal, Amita

doi:10.1111/j.1756-185x.2011.01659.x

Cited by 14 publications

(16 citation statements)

References 9 publications

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“…Chronic lupus peritonitis is usually observed in established lupus patients (Prasad et al 2012). Disease activity does not always correlate with its manifestation (Schousboe et al 1988;Kaklamanis et al 1991).…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

“…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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“…According to the literature, non-steroidal anti-inflammatory drugs (NSAIDs) 13 , antimala-rials 3,14 and immunosuppressive drugs including glucocorticoids 3,[15][16][17] , azathioprine 15,18 and cyclophosphamide 19 have been used in the management of LP-associated ascites. Patients usually respond well to steroids 16,17 .…”

Section: Discussionmentioning

confidence: 99%

“…While pleural or pericardial involvement is common, peritoneal involvement is relatively rare 1,2 . The lifetime prevalence of lupus peritonitis (LP) in a SLE patient is about 8-11% 3 .…”

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confidence: 99%

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

et al. 2014

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The $64,000 question

Keller

Schiavo

Wingo

et al. 2014

Journal of Hospital Medicine

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The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report. Similarly to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant. A 40-year-old Sudanese man was admitted due to worsening abdominal pain with recurrent ascites. He had a history of hepatitis B (HBV) infection and diabetes. He previously drank 3 beers per day on the weekends, but he had not consumed alcohol in over a year. He was born in Sudan but lived in Egypt most of his adult life; he immigrated to the United States 6 years previously. He was hospitalized out of state 9 months ago for "a swollen abdomen" and underwent an exploratory laparotomy that reportedly was unremarkable except for ascites.Portal hypertension due to liver disease is the most common cause of ascites. This patient has a known risk factor for liver disease (history of HBV infection). Although his reported alcohol consumption is low, there is a synergistic effect on liver injury in the setting of chronic hepatitis. Abdominal pain in the setting of ascites needs to be urgently evaluated to exclude spontaneous bacterial peritonitis (SBP). Also, because chronic HBV infection is the major risk factor for hepatocellular carcinoma in the world, malignant ascites is in the differential. Hepatic vascular thrombosis and tuberculous peritonitis (given the patient's country of origin and travel history) also should be considered. The most appropriate initial test would be a diagnostic paracentesis to support or exclude the presence of SBP and direct the evaluation toward liver disease or other less-common causes of ascites.The patient was seen as an outpatient 5 months prior to admission with transient fever and joint pains. Laboratory studies at that visit were notable for a serum albumin of 3.2 g/dL (normal 3.5-5), 2.4 g of predicted 24-hour protein on urinalysis (normal <30 mg per 24 hours), creatinine of 0.5 mg/dL (normal 0.8-1.3), and a positive hepatitis B surface antibody. The working diagnosis was a nonspecific viral syndrome and his symptoms resolved without treatment. One month later, he developed ascites and mild lower extremity edema. Additional laboratory studies at that time showed a normocytic anemia with hemoglobin 11.7 g/dL (normal 13.5-17.5) and leukopenia with white blood cell count of 2.4 3 10 9 /L (normal 3.5-10.5), neutrophil count of 1.45 3 10 9 /L (normal 1.7-7.0), and lymphocyte count of 0.58 3 10 9 /L (normal 0.90-2.90). Transaminases, serum bilirubin, prothrombin time, alpha fetoprotein, and peripheral blood smear were normal. Human immunodeficiency virus antibody screen and QuantiFERON-TB assay were negative. Hemoglobin A1c was 6.2% (normal 4.0-6.0). Repeat urinalysis demonstrated 883 mg of predicted 24-hour protein. Computed tomography (CT) of the abdomen showed a large amount of intra-abdominal ...

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Massive ascites as a presenting feature of lupus

Cited by 14 publications

References 9 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

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

The $64,000 question

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