Thrombotic microangiopathy involving the gallbladder as an unusual manifestation of systemic lupus erythematosus and antiphospholipid syndrome: Case report and review of the literature

Abstract

Gallbladder disease is no more common in patients with systemic lupus erythematosus (SLE) than in the general population. We describe a 17-year-old patient with SLE, who developed nephritis that was well controlled with medications. Initial treatment consisted of azathioprine, aspirin and prednisone with stable control of her symptoms. Two years later she developed a right quadrant abdominal pain, and an abdominal ultrasound revealed microlithiasic cholecystitis. Open cholecystectomy was performed and the histopathological findings revealed vasculitis with thrombotic microangiopathy in the gallbladder. This case presentation illustrates that calculous or acalculous cholecystitis should be considered as a manifestation of active SLE and APS.

A young woman with systemic lupus erythematosus and extensive mesenteric vasculitis involving small and medium vessels

“…Although mesenteric vasculitis due to catastrophic APS has also been described in the literature (17, 18), our patient did not have clinical evidence suggestive of active APS or diffuse thrombotic microangiopathy in her gallbladder or mesenteric vessels. The infarcts in her kidney and spleen noted on autopsy were most likely related to her vasculitis, leading to massive hemoperitoneum and subsequent low output state.…”

Relationship Between Gallbladder Distension and Lipid Profiles in Kawasaki Disease

“…In this study, GBD failed to show the association with inflammatory indices. GBD is thought to be secondary change from processes of vasculitis in the GB wall or an inflammatory change of bile duct 7). Therefore, GBD may be considered to be an another candidated clinical biomarker of inflammation in KD.…”

“…GBD has been reported in various autoimmune diseases such as rheumatoid arthritis, antiphospholipid syndrome, Henoch-Schönlein purpura and systemic lupus erythematosus 7)8). Gallbladder is the main organ of lipid metabolism.…”

Hemorrhagic cholecystitis and hemobilia: two infrequent complications of systemic lupus erythematosus

“…We think that the presence of cholelithiasis in a patient with SLE, pain on the right hypochondrium and analytic-ultrasound suspicion of cholecystitis demands a surgical treatment since the cause may be vascular, lithiasic or combined (9). Besides, the possible complications, as the ones described in this case, will be solved during the proper intervention and will not respond to pharmaceutical treatment for sure.…”