Tubo-Ovarian Mass Leading to Necrotizing Fasciitis in a Patient With Systemic Lupus Erythematosus: A Case Report

Acute abdominal pain is a common clinical problem in emergency and non-emergency cases. Acute abdomen in systemic lupus erythematosus (SLE) is a challenging diagnostic and therapeutic problem that carries high mortality and morbidity rates. The present study reports a case of a 45-year-old female, a known case of SLE, hypothyroidism, and seizure disorder. The patient presented with chief complaints of pain in the left iliac and lumbar region with a history of amenorrhea for three to four months. Based on the clinical findings, laboratory investigations, and diagnostic assessment involving ultrasonography (USG), the diagnosis of acute abdomen along with tubo-ovarian mass with dermoid cyst and SLE with lupus nephritis and seizure disorder was confirmed. The patient was operated with total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy with loop colostomy. The patient was placed in the surgical intensive care unit for observation; however, sepsis developed, and the trauma from the exploratory laparotomy led to septic shock, followed by hypotension and ultimately cardiac arrest. Hence, the cause of death was attributed to sepsis with shock and multiple organ dysfunction syndromes. In conclusion, acute abdomen in SLE suggests that systemic measurement and early laparotomy may improve the prognosis; however, due to chronic inflammatory status and immune-compromised state, the cases should be handled with utmost caution with a multidisciplinary approach due to the increase in the mortality rate.