Acute Acalculous Cholecystitis as a Presenting Manifestation in Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is known to involve the gastrointestinal tract, but gallbladder involvement is rare. The authors report the case of a 26-year-old postpartum female who presented with acute right upper quadrant abdominal pain and was diagnosed with acute acalculous cholecystitis (AAC). In the presence of concomitant features of nephritis, pericardial effusion, anaemia and positive ANA titre, the diagnosis of SLE was confirmed during hospitalisation. Histopathological analysis of the gall bladder revealed evidence of vasculitis. Although rare, AAC can be the first presentation of patients diagnosed with SLE. Prompt diagnosis and management results in a better patient outcome.

Although rare, acute acalculous cholecystitis is to be suspected in patients in the setting of right upper quadrant pain associated with multisystem disease as it may manifest as an initial symptom of the multisystem disease.In women with pre-existing rheumatological disease, a high index of suspicion for manifestations of postpartum flares should be maintained.Definitive treatment includes cholecystectomy; high-dose steroid therapy has been reported to be successful in a few cases.