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

Abstract

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.

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

“…In the present patient, peritoneal effusion was persistent, regardless of aggressive treatment with intravenous pulses of mPSL and IVCY, and immunoabsorption. Her peritonitis was very difficult to control compared to that in previous cases [1][2][3][4], and there was no previous report of severe gastrointestinal manifestations developing in a patient with chronic lupus peritonitis. In our patient, anti-ds DNA antibodies and ANA were detected in the peritoneal effusion, and, interestingly, the levels were higher than those in serum.…”

“…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]. In previous reports [1][2][3][4], treatment of chronic lupus peritonitis involved a moderate or high dose of corticosteroids and concomitant use of an immunosuppressant such as cyclophosphamide or azathioprine.…”

“…On the other hand, chronic lupus peritonitis is painless and responds poorly to corticosteroid therapy [1][2][3][4]. In previous reports [1][2][3][4], treatment of chronic lupus peritonitis involved a moderate or high dose of corticosteroids and concomitant use of an immunosuppressant such as cyclophosphamide or azathioprine. In the present patient, peritoneal effusion was persistent, regardless of aggressive treatment with intravenous pulses of mPSL and IVCY, and immunoabsorption.…”

“…Moreover, the titers of anti-ds DNA antibodies in the peritoneal effusion were remarkably elevated, and they had decreased after treatment. Anti-DNA antibodies and ANA have been reported to be detected in peritoneal effusions, and they may be related to immunological activity in the peritoneum [1,3]. However, no previous study investigated immunological findings in both serum and peritoneal effusion in patients with chronic lupus peritonitis receiving long-term treatment of.…”

“…However, chronic lupus peritonitis is a rare complication in patients with SLE and is reported to be difficult to control [1][2][3][4]. Patients with SLE sometimes develop small intestinal hemorrhaging as the result of a variety of causes, including enteritis, vasculitis, drug side effects, and infection.…”