1/13. Acute abdomen and lupus enteritis: thrombocytopenia and pneumatosis intestinalis as indicators for surgery.Bowel symptoms occur often in systemic lupus erythematosus (SLE), but enteric complications in patients on steroid therapy are rare. We report a case of a 14-year-old Mexican girl with SLE on high-dose steroid therapy complicated by abdominal vasculitis and small bowel perforation. Accompanying this serious complication were thrombocytopenia and radiographic changes of pneumatosis intestinalis. These findings suggested necrotizing enteritis and prompted urgent surgery. Four jejunal perforations, pneumatosis intestinalis, and submucosal vasculitis were present in the resected specimen. Persistent SLE activity responded to cyclophosphamide, which is indicated in patients with digestive symptoms who fail to respond to high-dose steroids.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
2/13. Lupus abdominal crisis owing to rupture of an ileocolic aneurysm with successful angiographic treatment.There are many causes of acute abdominal pain, or abdominal "crises," in patients with systemic lupus erythematosus (SLE), most frequently the causes are serositis or vasculitis. vasculitis generally causes small vessel abnormalities and may present with symptoms owing to mucosal damage, such as pain, diarrhea, or bleeding. We present a patient with SLE who had the acute onset of severe abdominal pain while hospitalized for a lupus flare and who was found to have a ruptured ileocolic aneurysm with intraperitoneal bleeding. She was successfully managed with angiographic embolization, without further complications. Although angiography is well established as a therapeutic intervention for mesenteric aneurysms of various etiologies, this is the first case of an SLE-related ileocolic aneurysm so managed. This entity should be considered in the differential diagnosis of abdominal pain in patients with lupus, and angiographic embolization should be considered in its management.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
3/13. Laparoscopically assisted treatment of acute abdomen in systemic lupus erythematosus.The incidence of abdominal pain in patients with systemic lupus erythematosus (SLE) is very high. Most patients do not require surgical treatment (serositis). Some cases such as appendicitis, perforated ulcer, cholecystitis or, rarely, intestinal infarction are surgical. Differential diagnosis is difficult, partly because noninvasive examinations do not provide enough evidence to rule out a diagnosis. On the other hand, in patients with SLE who have acute abdomen, it is dangerous to delay surgery by attempting conservative therapy. In fact, a better survival rate has been associated with early laparotomy. We report a case of acute abdomen in a patient affected by SLE, in which the diagnostic problem was solved by means of laparoscopy and the treatment was laparoscopically assisted. A 45-year-old woman with a 25-year history of SLE was admitted with abdominal pain and fever. Her physical examination revealed a painful right iliac fossa with rebound tenderness. Her WBC count was normal. Abdominal x-ray, ultrasonography, paracentesis, and peritoneal lavage did not provide a diagnosis. A diagnostic laparoscopy was performed, showing segmentary small bowel necrosis. The incision of the umbilical port site was enlarged to allow a small laparatomy, and a small bowel resection was performed. The histopathologic finding was "leucocytoclasic vasculitis, with infarction of the intestinal wall." The patient recovered uneventfully. In conclusion, this case report shows that emergency diagnostic laparoscopy is feasible and useful for acute abdomen in SLE. Currently, this diagnostic possibility could be considered the technique of choice in these cases, partly because, when necessary, it also can allow for mini-invasive treatment therapy.- - - - - - - - - - ranking = 5keywords = erythema (Clic here for more details about this article) |
4/13. Intestinal ischemia as the first manifestation of vasculitis.OBJECTIVE: To summarize current knowledge regarding the diagnosis and management of gastrointestinal vasculitis. methods: Three cases of gastrointestinal vasculitis with acute abdominal ischemia as their first manifestation are presented. Underlying diseases were microscopic polyangiitis, systemic lupus erythematosus (SLE), and polyarteritis nodosa (PAN). Relevant English-language articles collected from the pubmed database were reviewed. RESULTS: Among the angiitides, PAN, SLE, and Henoch-Schonlein are those most commonly accompanied by gastrointestinal complications. Intestinal vasculitis usually occurs when there is evidence of generalized disease activity. Abdominal computerized tomography is a valuable tool for diagnosing intestinal ischemia and suspected vasculitis. CONCLUSIONS: In young patients presenting with intestinal ischemia, it is essential to assess the possibility of an underlying systemic disease. With prompt initiation of immunosuppressive treatment, surgery may be avoided. prognosis is improved when there is minimal delay in surgical intervention.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
5/13. Dramatic development of severe SLE in a patient with an incomplete disease.This case report describes the previously-unreported clinical course of a patient with a so-called incomplete systemic lupus erythematosus (SLE), i.e. symptoms related to one organ system only, together with the presence of ANA. He had an indolent course initially and developed, 6 months after the first symptoms, a severe disease with rapid appearance of major and unusual manifestations. The possibility of fast progression and a grave course of an incomplete SLE should be kept in mind. This report is meant to heighten awareness of such an atypical presentation so that prompt and aggressive immunosuppressive therapy may be instituted.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
6/13. Abdominal computed tomography in lupus mesenteric arteritis.We report the abdominal computed tomography (CT) findings in a patient with systemic lupus erythematosus who developed signs of an acute abdomen secondary to mesenteric arteritis. Initial CT scan demonstrated ascites and wall thickening of the duodenum and jejunum. After treatment with high dose intravenous steroids, follow-up CT scan demonstrated a normal duodenum and small bowel. This is the first surgically proven case of lupus mesenteric arteritis resulting in bowel ischemia that is demonstrated on CT before and after medical therapy. Lupus mesenteric arteritis should be included in the differential diagnosis of causes of bowel wall thickening and ischemia, especially if mesenteric vessels appear prominent.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
7/13. A papular eruption and acute abdominal pain associated with coxsackie A-14 virus.A 14-year-old girl who was admitted to hospital with acute abdominal pain developed an erythematous papular eruption which persisted for 4 weeks. Examination of a stool specimen yielded evidence of a coxsackie A-14 virus.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
8/13. Abdominal computed tomography scan in acute lupus abdominal serositis.This report demonstrates the value of abdominal computed tomography in the evaluation and management of a patient with abdominal complaints due to systemic lupus erythematosus.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
9/13. Acute abdominal complications of systemic lupus erythematosus.Four patients with acute abdominal complications of systemic lupus erythematosus requiring laparotomy are presented. The complications consisted of intestinal ischaemia, without perforation, in 3 patients and omental infarction in the fourth. In 2 patients the abdominal emergency was the first manifestation of the collagen disease. Tissue removed from 3 patients showed a marked vasculitis on histological examination. The pathogenesis and management of acute abdominal complications of systemic lupus erythematosus are discussed and the literature reviewed.- - - - - - - - - - ranking = 6keywords = erythema (Clic here for more details about this article) |
10/13. Acute abdomen in systemic vasculitides.A presentation is made of abdominal vasculitis in the course of systemic lupus erythematosus (SLE) and polyarteritis nodosa (PAN). The disease is not yet completely known and therefore it is often incorrectly diagnosed as acute abdomen requiring surgery. An accurate diagnosis of this disease is essential for the choice of the correct therapeutic attitude. Some theoretical aspects of the disease are discussed and the personal experience of the authors resulting from the study of some cases hospitalized in the Institute of internal medicine, are discussed.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
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