Hepatic infarction in a hemodialysis patient with systemic lupus erythematosus

Hepatic infarction remains a rare and dramatic presentation of an acute abdomen in patients with systemic lupus erythematosus. It can be recognized preoperatively only with a high index of suspicion. Imaging studies such as abdominal computed tomography may aid in making the diagnosis. The tendency for thrombosis in these patients often can be associated with the presence of circulating anticoagulants from a group of antiphospholipid antibodies. The finding of lupus anticoagulant or anticardiolipin antibodies can help identify those patients more prone to thrombotic episodes, although at present it cannot be assumed that these antibodies cause the thromboses. Hemodialysis patients are said to have a decreased tendency for vascular thrombosis, but this may not be true in the presence of circulating antiphospholipid antibodies. We report a case of histologically documented hepatic infarction secondary to thrombosis in an end-stage renal disease patient on hemodialysis with systemic lupus erythematosus and a circulating lupus anticoagulant.