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Acute acalculous cholecystitis as the initial manifestation of systemic lupus erythematous: A case report.
- Source :
-
Medicine [Medicine (Baltimore)] 2021 Jun 04; Vol. 100 (22), pp. e26238. - Publication Year :
- 2021
-
Abstract
- Rationale: Acute acalculous cholecystitis (AAC) is an extremely rare manifestation of systemic lupus erythematous (SLE). In previous reports, most of the patients were already diagnosed cases of SLE upon confirmation of AAC.<br />Patient Concerns: A 24-year-old female who initially presented with fever and acute right upper quadrant abdominal pain. She had no medical history.<br />Diagnoses: Abdominal ultrasonography and computed tomography (CT) showed gallbladder thickening with pericholecystic edema without gallstones or sludge, demonstrating acalculous cholecystitis. She revealed discoid rash on the both shin. Laboratory tests revealed pancytopenia. The titer of antinuclear antibody (ANA) was 1:1280. Anti-dsDNA antibody, anti-phospholipid antibody, anti-Sm antibody test, and proteinuria in 24 hours were positive. Both C3 and C4 were low. Echocardiography and chest CT showed pericardial effusion and pleural effusion. Using the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria, the score was 31. We thought AAC of this case that was one of the initial manifestations of SLE.<br />Interventions: The patient was treated with high-dose prednisolone (1 mg/kg) and hydroxychloroquine 400 mg.<br />Outcomes: After 4 days of administration of high-dose corticosteroid therapy, symptoms rapidly improved. After 35 days of the treatment, her symptoms and disease activity of SLE were markedly improved.<br />Lessons: Although AAC being the initial manifestation of SLE is very rare, prompt diagnosis and management with corticosteroids precluded surgical intervention. Physicians need to be cognizant of AAC as a disease flare and as a rare initial manifestation of SLE.<br />Competing Interests: The authors have no conflicts of interests to disclose.<br /> (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
- Subjects :
- Acalculous Cholecystitis diagnosis
Acute Disease
Adult
Aged
Antibodies, Antinuclear blood
Antirheumatic Agents administration & dosage
Antirheumatic Agents therapeutic use
Child
Drug Therapy, Combination
Echocardiography methods
Female
Gallbladder diagnostic imaging
Glucocorticoids administration & dosage
Glucocorticoids therapeutic use
Humans
Hydroxychloroquine administration & dosage
Hydroxychloroquine therapeutic use
Lupus Erythematosus, Systemic blood
Lupus Erythematosus, Systemic diagnosis
Lupus Erythematosus, Systemic drug therapy
Pericardial Effusion diagnosis
Pleural Effusion diagnosis
Prednisolone administration & dosage
Prednisolone therapeutic use
Proteinuria diagnosis
Proteinuria etiology
Tomography, X-Ray Computed methods
Treatment Outcome
Ultrasonography methods
Young Adult
Acalculous Cholecystitis etiology
Gallbladder pathology
Lupus Erythematosus, Systemic complications
Subjects
Details
- Language :
- English
- ISSN :
- 1536-5964
- Volume :
- 100
- Issue :
- 22
- Database :
- MEDLINE
- Journal :
- Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 34087909
- Full Text :
- https://doi.org/10.1097/MD.0000000000026238