Ascites as the Presenting Sign of Systemic Lupus Erythematosus

Cook, Samuel G

doi:10.7759/cureus.23231

Cited by 4 publications

(7 citation statements)

References 7 publications

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“…Ascites were formerly considered to exclusively manifest in cases of nephrotic syndrome, Budd‐Chiari syndrome, and protein‐losing enteropathy 6,7 . Nonetheless, 10% of SLE patients also experience ascites 8 . Ascites that accompany acute peritonitis as the initial presentation for lupus are incredibly uncommon, and to our knowledge, a few cases in the literature have mentioned this presentation in juvenile patients, while other related cases have also occurred in well‐known SLE patients 7,9 .…”

Section: Discussionmentioning

confidence: 95%

“… 6 , 7 Nonetheless, 10% of SLE patients also experience ascites. 8 Ascites that accompany acute peritonitis as the initial presentation for lupus are incredibly uncommon, and to our knowledge, a few cases in the literature have mentioned this presentation in juvenile patients, while other related cases have also occurred in well‐known SLE patients. 7 , 9 In the literature, active lupus disease, fever, and high d ‐dimer are significantly associated with serositis.…”

Section: Discussionmentioning

confidence: 99%

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Protein‐losing enteropathy as the first presentation of systemic lupus erythematosus: A case report from Sudan

Abdalla,

Mohymeed,

Nail

et al. 2023

Clinical Case Reports

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Key Clinical Message In low‐ and middle‐income countries, protein‐losing enteropathy is a diagnosis of exclusion. SLE should be on the list of differential diagnoses of protein‐losing enteropathy, especially if the patient had a long history of GI symptoms and ascites. Abstract Protein‐losing enteropathy can rarely be the initial presentation of systemic lupus erythematosus (SLE). Protein‐losing enteropathy is a diagnosis of exclusion in low‐ and middle‐income countries. Protein‐losing enteropathy in SLE should be in the list of differential diagnosis of unexplained ascites, especially if patient had long history of gastrointestinal symptoms. We present a case of 33 years old male with long standing gastrointestinal symptoms and diarrhea attributed previously to irritable bowel syndrome. Presented with progressive abdominal distension, and diagnosed with ascites. Workup for him showed leucopenia, thrombocytopenia, hypoalbumenemia, elevated inflammatory markers (ESR 30, CRP 6.6), high cholesterol level (306 mg/dL), normal renal profile and normal urine analysis. Ascitic tab pale yellow with SAAG 0.9 and positive for adenosine deaminase (66 u/L) sugesstive for tuberculous peritonitis although quantitative PCR and geneXpert for MBT was negative. Antituberculous treatment was started and his condition deteriorated, immediately antituberculous was withdrawal. Further tests revealed positive serology for ANA (1:320 speckled pattern) with positive anti‐RNP/Sm, positive anti‐Sm antibodies. Complements level were normal. He started immunosuppressive therapy (prednisolone 10 mg/day, hydroxychloroquine 400 mg/day, azathioprine 100 mg/day). In addition, his condition is improved Diagnosis was made as SLE with Protein‐losing enteropathy based on hypoalbumenemia (with exclusion of renal loss of protein), ascites, hypercholesrtolemia and exclusions of other mimics as explained later. As well as positive response to immunosuppressive medications. Our patient diagnosed clinically as SLE with protein‐losing enteropathy. Protein‐losing enteropathy in SLE is challenging in diagnosis because of its rarity as well as limitations in its diagnostic tests.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Protein‐losing enteropathy as the first presentation of systemic lupus erythematosus: A case report from Sudan

Abdalla,

Mohymeed,

Nail

et al. 2023

Clinical Case Reports

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“…Differentials such as appendicitis, cholecystitis, pancreatitis, perforated peptic ulcer, mesenteric vasculitis, malabsorption, intestinal pseudo-obstruction, and mesenteric insufficiency, among others, must be suspected and discarded before making a diagnosis of lupus peritonitis 3 . The overall incidence of ascites as a first sign of SLE is very rare 4 , mainly derived from case reports and associated with a more complex gastrointestinal clinical picture. Potential causes are lupus peritonitis, protein-losing enteropathy, nephrotic syndrome, and constrictive pericarditis 4 .…”

Section: Discussionmentioning

confidence: 99%

“…The overall incidence of ascites as a first sign of SLE is very rare 4 , mainly derived from case reports and associated with a more complex gastrointestinal clinical picture. Potential causes are lupus peritonitis, protein-losing enteropathy, nephrotic syndrome, and constrictive pericarditis 4 . As some authors argue, the relevancy of its suspicion is that pathophysiological mechanisms of active SLE with peritoneum inflammation as the only cause are a diagnosis of exclusion 5 .…”

Section: Discussionmentioning

confidence: 99%

An early postpartum young woman with ascites and fever: a case report of a rare presentation of SLE

García-Sarreón¹,

Garcia-Treviño²,

Violante-Cumpa³

2023

RMU

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Introduction.Peritoneal involvement in systemic lupus erythematosus (SLE) is rare and is even rarer in the presence of clinically evident ascites. Case presentation. A 23-year-old female in the early puerperium is admitted to the Emergency Department for abdominal pain. She had fever and visible ascites. Laboratories demonstrated lymphopenia, leukocytosis, and acute kidney injury with proteinuria. Peritoneal fluid showed a cellular count of 338 leukocytes/mL, with negative cultures. Specific antibodies demonstrated SLE. The use of steroids and cyclophosphamide showed clinical improvement. Discussion. Peritoneal involvement in SLE is uncommon, reported in 16% of cases. It needs to be suspected in patients with SLE and abdominal pain.

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“…Other potential causes of chylous ascites, including tuberculosis, filariasis, liver cirrhosis, neoplastic and traumatic factors, were excluded [ 16 ]. Lupus peritonitis was also excluded because of a serum-ascites albumin gradient greater than 1.1 [ 17 ]. Finally, coughing and difficultly in defecation were probably the causes in the present RSH [ 13 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

A 28-Year-Old Woman Presenting with a Clinical Flare of Systematic Lupus Erythematosus and Abdominal Pain Due to Rectus Sheath Hematoma

et al. 2022

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Patient: Female, 28-year-old Final Diagnosis: Class III (A/C) and class V lupus nephritis • neuropsychiatric systemic lupus erythematosus • rectus sheath hematoma • systemic lupus erythematous Symptoms: Abdominal pain • edema • abdominal distension • frothy urine • cough • slight dyspnea Medication: — Clinical Procedure: — Specialty: Nephrology • Rheumatology Objective: Rare coexistence of disease or pathology Background: A flare, or flare-up, of systematic lupus erythematosus (SLE) is diagnosed by an increase in disease activity in one or more organs, new symptoms, or changes in laboratory measurements. A hematoma can occur in the sheath of the rectus abdominis following muscle trauma or rupture of an epigastric vessel, or it can occur spontaneously. This report is of a 28-year-old woman who presented with a clinical flare of SLE and abdominal pain due to rectus sheath hematoma. Case Report: A 28-year-old woman had been suspected of having SLE 9 years ago and had received glucocorticoid therapy combined with hydroxychloroquine. However, lupus flared after she discontinued glucocorticoids, and she was admitted with a 1-month history of marked generalized edema, abdominal distension, frothy urine, and massive ascites. During hospitalization, she abruptly developed a continuous, stabbing abdominal pain and a bulge over the right abdomen as a result of straining during a bowel movement. On examination, a well-demarcated round mass that measured 121×96 mm was detected in the right quadrant. Abdominal emergency computed tomography revealed a right rectus sheath hematoma (21.4×4.7 cm). After her condition improved, the patient underwent an ultrasound-guided renal biopsy and was diagnosed with class III (A/C) and class V lupus nephritis. Conclusions: This case has shown that spontaneous rectus sheath hematoma can occur without a history of trauma in a patient with an exacerbation of SLE. This association appears to be rare, and the cause is unknown.

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Ascites as the Presenting Sign of Systemic Lupus Erythematosus

Cited by 4 publications

References 7 publications

Protein‐losing enteropathy as the first presentation of systemic lupus erythematosus: A case report from Sudan

Protein‐losing enteropathy as the first presentation of systemic lupus erythematosus: A case report from Sudan

An early postpartum young woman with ascites and fever: a case report of a rare presentation of SLE

A 28-Year-Old Woman Presenting with a Clinical Flare of Systematic Lupus Erythematosus and Abdominal Pain Due to Rectus Sheath Hematoma

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