A CASE OF LUPUS PERITONITIS IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract

A 49-year-old woman was referred to the hospital because of lower abdominal pain on March 31, 1997 which appeared 6 days before, and was treated with a suspicion of acute enteritis on an ambulant basis. She had a 24-year history of systemic lupus erythematosus (SLE) and had been recently controlled by prednisolone at a dose of 5-10mg a day at another hospital. On April 14, the patient was emergently admitted to the hospital because a collection of ascites was suspected, though the abdominal pain was slightly relieved. Abdominal CT on admission revealed a large volume of ascites and intestinal edema. We had a conference with medical doctors based on the nature of ascites and blood analysis data (low CHSO and high anti DNA antibody), and diagnosed the case as lupus peritonitis caused by angitis and serositis of mesentery associated with exacerbated SLE. According to the diagnosis, a steroid pulse therapy was started and symptomatic remission as well as improvement in laboratory data were attained.
It is not uncommon that the patients with SLE have gastrointestinal symptoms, but sometimes, there have been sporadic reports that described the difficulty in differentiation of those GI symptoms from acute abdomen in the literature. We surgeons have a great difficulty in diagnosis and treatment of the symptoms, because it directly relates with SLE itself rather than as complication. We should recognize that SLE is not an unrelated disease to surgeons.