Successful treatment using corticosteroid combined antibiotic for acute acalculous cholecystitis patients with systemic lupus erythematosus

Abstract

There is no consensus of treatments for acute acalculous cholecystitis with systemic lupus erythematosus (SLE). The study was aimed to investigate the effect of the corticosteroid for these patients.A series of patients who were diagnosed as acute acalculous cholecystitis with SLE in the period from January 2012 to December 2016 at our hospital were included. They accepted 2 different conservative treatment strategies initially: the treatment using moxifloxacin (the antibiotic group), and the treatment using corticosteroid combined moxifloxacin (the corticosteroid group). Then clinical manifestations, laboratory features, and outcomes were analyzed.The study identified 22 women Han Chinese patients with the SLE history of 2.8 ± 1.4 year. There was no significant difference in SLE history, Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2000), Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SLICC/ACR), hematologic examination results, and corticosteroid dosage between 2 groups. And there was no significant difference in the symptom of acute cholecystitis, duration of the symptoms, white blood level, and the thickness of gallbladder wall between 2 groups either. However, the SLEDAI-2000 of the corticosteroid group was lower than that of the antibiotic group (7.3 ± 1.4 vs 10.7 ± 3.0, P = .03), so was the SLICC/ACR (0.1 ± 0.3 vs 0.3 ± 0.5, P = .01). Moreover, total 11 of 12 patients were successfully treated in the corticosteroid group, only 1 patient got cholecystectomy because no improvement after conservative treatment. While 4 of 10 patients were successfully treated by moxifloxacin alone, 6 patients had to accept cholecystectomy in the antibiotic group. The rate of successful conservative treatment in the corticosteroid group was higher than that of the antibiotic group (P = .02). All patients were followed up at least 6 months, there was no statistical difference in the rate of recurrence of abdominal pain between 2 groups (P = .37).The corticosteroid plays an important role in the management of the acalculous cholecystitis patient with SLE, and it should be considered as a first line of treatment.

Acute acalculous cholecystitis as the initial manifestation of systemic lupus erythematous

“…However, there was also a case requiring subsequent cholecystectomy among previously reported cases treated with corticosteroids. [ 18 ] The patient's general condition and risk factors are important in the medical or surgical treatment decisions. In our case, because the patient was stable and had no risk factors for AAC complications, we considered high-dose corticosteroid with hydroxychloroquine as the initial treatment for SLE-associated AAC.…”

Systemic Lupus Erythematosus-associated Acute Acalculous Cholecystitis Successfully Treated by a Corticosteroid Combined with Azathioprine

“…(Table 3) (34-38,47). Among 13 previously reported cases treated with corticosteroid combined with antibiotics, 2 failed the treatment and required subsequent cholecystectomy (38,47). In other reports, however, two cases were treated successfully with corticosteroid combined with immunosuppressive agents (35,36).…”

“…Generally, three prevailing therapies are considered for AAC: cholecystectomy, laparoscopic cholecystectomy, and percutaneous cholecystostomy (1,28). For SLE-associated AAC, corticosteroid therapy was successfully used in some reports as a conservative therapy (34)(35)(36)(37)(38). In previous reports of SLE-associated AAC conservatively treated with corticosteroids, antibiotics or immunosuppressive agents were used in combination with corticosteroids.…”

“…In previous reports of SLE-associated AAC conservatively treated with corticosteroids, antibiotics or immunosuppressive agents were used in combination with corticosteroids. (Table 3) (34)(35)(36)(37)(38)47). Among 13 previously reported cases treated with corticosteroid combined with antibiotics, 2 failed the treatment and required subsequent cholecystectomy (38,47).…”

“…Serositis and mesenteric inflammatory veno-occlusive disease (MIVOD) are also reported as possible pathogeneses of AAC (32,33). Corticosteroids have been successfully used in some cases as a conservative therapy for SLE-associated AAC (34)(35)(36)(37)(38). However, only a few reports have examined effective drugs for use in combination with corticosteroids.…”