A 45-year-old woman with systemic lupus erythematosus (SLE) that began at the age of 28 was admitted to the hospital because of acute lower abdominal pain and high fever. On admission, body temperature was 39.7°C. The laboratory findings showed that WBC was 11700/mm3, CRP was 17.7mg/dl, and serum anti-nuclear antibody was positive to a dilution of 1:20 with speckled pattern. The levels of C3, C4, CH50 and immunoglobulin were within normal limits. Neither pleural nor pericardial effusion was detected on chest X-ray films. An abdominal X-ray film showed a lot of small intestinal gas. Little peritoneal effusion was detected by pelvic CT. We suspected more acute bacterial peritonitis than lupus peritonitis with SLE. Laparotomy was carried out under a diagnosis of acute peritonitis. There was serous ascites, but no definitive findings of intestinal perforation, appendicitis or ischemic enteritis were found. A diagnosis of lupus peritonitis was made. Prednisolone was administered following the laparotomy. But the patient died of heart and lung failure on postoperative day 4. In this case, no immunological study of the ascites nor histologic exploration of the peritoneum was conducted, but we diagnosed with acute lupus peritonitis associated with recurrence of SLE based on her clinical course and intraoperative findings.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)