Systemic Lupus Erythematosus Simulating Acute Surgical Condition of the Abdomen

Pollak, Victor E.; Grove, William J.; Kark, Robert M.; Muehrcke, Robert C.; Pirani, Conrad L.; Steck, Irving E.

doi:10.1056/nejm195808072590602

Cited by 127 publications

(36 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Esto incluye la vasculitis necrotizante (12), la oclusión arterial y arteriolar por trombos resultantes tanto de la hipotensión severa o como del síndrome antifosfolípido (13,14), engrosamiento y proliferación intimal (15) y depósito de inmunocomplejos con activación del complemento en la pared de las arterias pancreáticas (16). Ninguno de nuestros casos padecía síndrome antifosfolípido, pero quizás el caso 1 muestra la más clara evidencia de la implicación vascular, considerando la amplia cantidad de complicaciones vasculares que la paciente había presentado, incluso llevándola a la muerte una de ellas.…”

Section: Discussionunclassified

“…This includes necrotizing vasculitis syndrome (12), occlusion of arteries and arterioles by thrombi resulting from severe hypotension or antiphospholipid syndrome (13,14), intimal thickening/proliferation (15), and immune complex deposition with complement activation in the wall of pancreatic arteries (16). None of our cases had antiphospholipid syndrome but perhaps case 1 is the clearest evidence of vascular involvement, considering the amount of vascular complications she had, one of them leading to her death.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pancreatitis and Systemic Lupus Erythematosus

1958

N Engl J Med

View full text Add to dashboard Cite

Gastrointestinal symptoms in patients with SLE are common, specifically abdominal pain. However, the rate of pancreatic diseases is much lower and does not reach 5% according to published series in Europe and the USA. This association between SLE and pancreatic disease is basically at the expense of episodes of acute pancreatitis. An association with chronic pancreatitis is much more uncommon, and only four articles have been published showing this relationship.Three cases of SLE-associated pancreatitis are described, and disease onset, etiological factors, and clinical progression are analyzed. A review of the literature and a brief discussion about pathophysiological mechanisms and the role of corticosteroids are also included.Key words: Systemic lupus erythematosus. Acute pancreatitis. Chronic pancreatitis. INTRODUCTIONSince the first association between systemic lupus erythematosus (SLE) and pancreatitis was documented by Reifenstein et al. in 1939 (1), very few reports about the prevalence of pancreatic diseases in this rheumatologic disorder have been reported.Gastrointestinal symptoms in patients with SLE are common, specifically abdominal pain; as described in some series, it has been shown to have a prevalence of 19.2% (2). The rate of pancreatitis in patients with SLE varies depending on individual series from Europe and the United States between 0.7 and 4% (3,4). This association is mainly at the expense of acute episodes of pancreatitis; however only four reports have been published regarding this relationship with chronic pancreatitis (5-7).Three cases of SLE-associated pancreatitis are described, and disease onset, etiological factors and clinical progression are analyzed. A review of the literature and a brief discussion about the pathophysiological mechanisms and the role of corticosteroids are also included. METHODSA retrospective review of hospital admissions at Gastroenterology Department, University Hospital, Santiago de Compostela during 2001-2005 with the dual diagnosis of systemic lupus erythematosus and pancreatitis was made. Demographic data, clinical intervention, and progression parameters of pancreatic disease were identified. These patients were collected by searching our institution's computer database using the key words "pancreatitis" and "SLE". Demographic information registered from the medical charts included subject age, gender, time (years) from the initial diagnosis of SLE, alcohol abuse, medications, specially corticosteroids, and criteria used for SLE diagnosis.Clinical data collected included symptoms, SLE activity with a list of organs or systems involved, initial pancreatic enzymes, number of admissions for pancreatitis, and serologies for antinuclear antibodies (ANA) and C-reactive protein levels. All radiological results were documented, including abdominal ultrasounds, helical CT, cholangiopancreatic resonance (MRPC), endoscopic retrograde cholangiopancreatography (ERPC), and endoscopic ultrasounds (EUS

show abstract

Section: Discussionunclassified

Section: Discussionmentioning

confidence: 99%

Pancreatitis and Systemic Lupus Erythematosus

1958

N Engl J Med

View full text Add to dashboard Cite

show abstract

“…Acute abdominal complications are not rare in sys temic lupus erythematosus (2,6). Several case reports of bowel ischemia (2), gastrointestinal hemorrhage (7), bowel obstruction (8) , spontaneous rupture of the spleen (9), spontaneous rupture of the liver (10) and acute pancreatitis (2), which required surgical therapy have been published.…”

Section: Discussionmentioning

confidence: 99%

“…Some cases show latent morbidity occasionally interrupted by acute intermittent flares, and others have very slowly evolving lesions. Both bacterial panperitonitis and lung alveolar hemorrhage are rare but these are some of the most life threatening complications of SLE (2)(3)(4). The latter in particular has been shown to have a very high mortality rate in several case reports published in the last two decades (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Lupus Nephritis Associated with Bacterial Panperitonitis and Lung Alveolar Hemorrhage.

et al. 1992

View full text Add to dashboard Cite

A 36 year-old woman was admitted to the hospital with the diagnosis of nephrotic syndrome due to lupus nephritis. The patient had panperitonitis caused by Staphylococcus aureus as a complication, and an emergency laparotomy was performed. After the operation, the patient developed a massive lung alveolar hemorrhage. Methylprednisolone pulse therapy showed a marked effect on the lung hemorrhage. It is known that lung alveolar hemorrhages associated with systemic lupus erythematosus have a very high mortality; the present case is relatively rare because of the good response to steroid pulse therapy. (Internal Medicine 31: 678-681, 1992)

show abstract

“…Although patients with SLE have abdominal complaints, these symptoms are rarely acute and severe enough to simulate a surgical abdominal emergency (8,9). When a surgical abdomen has resulted from SLE, the etiologies have included inflammation of the peritoneal surface or an arteritis of the intestine or pancreas.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of the liver

Levitin

Sweet

Brunner

et al. 1977

Arthritis & Rheumatism

View full text Add to dashboard Cite

A patient with systemic lupus erythematosus developed an acute surgical abdomen secondary to spontaneous rupture of the liver and died. Postmortem examination revealed an arteritis of the liver, pancreas, adrenal gland, skeletal muscle, and spleen. It appeared that an arteritis of the liver produced areas of infarction that ruptured and caused the clinical findings.The clinical features of patients with systemic lupus erythematosus (SLE) vary depending on the organs involved. One organ, the liver, is rarely involved with clinically significant disease ( I ) . We report an unusual case of SLE with spontaneous rupture of the liver secondary to arteritis. CASE REPORTA 27-year-old black female with SLE was admitted to the University of Virginia Medical Center for evaluation of Submitted for publication May 7. 1976; accepted September 27. 1976. renal failure. SLE was diagnosed in 1967 because of Raynaud's phenomenon, arthritis, malar facial rash, sun sensitivity, and positive lupus erythematosus cell test and serum fluorescent antinuclear antibody test. She responded to prednisone. which was discontinued in 1970. Later she took aspirin for intermittent arthritis. She remained relatively well until the twenty-fourth week of her fourth pregnancy, when proteinuria was first detected. At that time a creatinine clearance was normal. but serum concentration of C3 was low. One month before admission, following the delivery of a 32-week old baby. she developed intermittent abdominal pain, hypertension, ascites. and a n elevated serum creatinine (3.5 mg/dl).On physical examination the patient was in no acute distress. Vital signs were normal except for a blood pressure of 160/100 rnm Hg. There was mild erythema and hypopigmentation over the bridge of the nose and rnalar area. A grade 2/6 systolic ejection murmur was heard along the left sternal border without radiation. The abdomen was nontender, tense with fluid, and without organomegaly. Pelvic and rectal examinations were unremarkable. Edema of the legs and sacrum were noted, as were small effusions of both knees.Admission laboratory data included a blood urea nitrogen of 58 mg/dl, serum creatinine 2.9 mg/dl, serum albumin 2.5 mg/dl, urinalysis 3+ protein with 9 white cells per high power field, a 24-hour total urine protein of 2.8 g. hematocrit 34% and white blood count 9400/mm3, positive fluorescent antinuclear antibody test, and total hernolytic complement 21 units (normal: 3 4 4 8 units). Cryoglobulins, anti-DNA antibody, and Clq precipitable immune complexes were not detected. Roentgenograms of the abdomen showed diffuse haziness consistent with intraperitoneal fluid. A chest roentgenogram demonstrated elevated diaphragms bilaterally with right basilar atelectasis. A diagnostic paracentesis yielded clear yellow fluid with 48 white blood cells/mm3 (56% polymorphonuclear leukocytes and 44% monocytes), glucose of 103 mg/dl, and protein of 3.0 g/dl. N o organisms were cultured from the fluid and malignant cells were not revealed by cytologic examination.

show abstract

Systemic Lupus Erythematosus Simulating Acute Surgical Condition of the Abdomen

Cited by 127 publications

References 11 publications

Pancreatitis and Systemic Lupus Erythematosus

Pancreatitis and Systemic Lupus Erythematosus

Lupus Nephritis Associated with Bacterial Panperitonitis and Lung Alveolar Hemorrhage.

Spontaneous rupture of the liver

Contact Info

Product

Resources

About