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[Two cases of acute lupus peritonitis]
H Ideguchi1, M Misumi, Y Inoue
1First Department of Internal Medicine, Yokohama City University School of Medicine, Fukuura, Kanazawa-ku, Yokohama-city.
Ryumachi. [Rheumatism]
|February 24, 2001
Summary
Systemic lupus erythematosus (SLE) can present as acute peritonitis, characterized by abdominal pain and ascites. Prompt steroid therapy often improves symptoms, but complications like lupus nephritis may require further treatment.
Area of Science:
- Rheumatology
- Gastroenterology
- Internal Medicine
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
- Lupus peritonitis (LP) is a rare but serious complication of SLE, often presenting with acute abdominal symptoms.
- Distinguishing acute from chronic LP is crucial for appropriate management and predicting treatment response.
Observation:
- Two cases of SLE diagnosed with acute peritonitis are presented, highlighting initial gastrointestinal and urinary symptoms.
- Peritoneal fluid analysis revealed exudative fluid with positive autoantibodies in both cases.
- High-dose steroid therapy led to prompt improvement in abdominal symptoms and ascites, although lupus nephritis necessitated additional treatment.
Findings:
- Acute lupus peritonitis commonly presents with abdominal pain, vomiting, and diarrhea, unlike chronic LP which is often asymptomatic with ascites and serositis.
- Fever, arthritis, central nervous system involvement, and cystitis are more frequent in acute LP.
- Pleural and pericardial effusions are more characteristic of chronic LP.
- Steroid therapy demonstrates a better response in acute LP cases.
Implications:
- Early recognition of lupus peritonitis as a presenting manifestation of SLE is vital for timely diagnosis and intervention.
- Understanding the distinct clinical features of acute versus chronic LP aids in patient stratification and therapeutic planning.
- Management of LP requires a comprehensive approach, addressing both peritoneal inflammation and potential systemic complications like lupus nephritis.