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AB0537 Acute acalculous cholecystitis: a rare manifestation of systemic lupus erythematosus
  1. T Ben Salem,
  2. A Kefi,
  3. M Jedidi,
  4. M Lamloum,
  5. I Ben Ghorbel,
  6. MH Houman
  1. Internal Medicine, Rabta university hospital, Tunis, Tunisia

Abstract

Background Acute acalculous cholecystitis (AAC) is a rare complication of systemic lupus erythematosus (SLE) but should be recognized

Objectives The aim was to describe clinical, biological and radiological features of AAC in SLE patients.

Methods We report four cases of AAC complicating SLE among 246 patients.

Results Case 1: A 37-year-old woman with one year history of arthralgia and Raynaud's phenomenon was admitted for fever, cutaneous lesions, nausea and abdominal pain. The right upper quadrant of the abdomen was tender and we noted oral ulcerations and wrist synovitis. Laboratory data showed lymphopenia, hemolytic anemia and an inflammatory syndrome. There was no cholestasis or cytolysis. Antinuclear antibodies (ANA), anti-nucleosome, anti-Sm and anti-ribosome antibodies were positive. Abdominal sonography revealed ascites and gallbladder wall was thick and irregular. The diagnosis of AAC complicating a SLE was made and patient was treated with antibiotics and corticosteroids. Two weeks later, she was asymptomatic and abdominal sonography was normal.

Case 2: A 32-year-old woman had SLE with arthralgia, cutaneous manifestations, hematological involvements and pulmonary hypertension; she was treated with corticosteroids and cyclophosphamide. Six month later, at time of the second pulse of cyclophosphamide, she presented with jaundice and tender hepatomegaly without abdominal pain. Liver enzymes rates were normal except bilirubin which was high at 47 UI. Her abdominal sonography showed gallbladder wall thickness without bile ducts enlargement or gallstones. Patient was continued on steroids and cyclophosphamide but she died because of heart failure.

Case 3: A 40-year-old patient with 12-year-history of SLE was admitted for fever and dyspnea. On physical examination, there was tenderness on right upper quadrant of her abdomen. Cholestasis and cytolysis were found. Abdominal sonography showed a striated and thick gallbladder wall (17 mm). Computer tomography confirmed the gallbladder wall thickness and note pericholecystic edema. Patient was also diagnosed with myocarditis and seritis. A new SLE relapse was obvious and she was treated with prednisone 1 mg/kg/day and azathioprine. The outcome was good and she still is asymptomatic.

Case 4: A 56-year-old-woman was admitted with abdominal pain and fever, limbs paresthesia. Abdominal examination was normal. Biological data showed anemia, thrombopenia and cholestasis. ANA, anti-DNA and anti-Sm were positive. Abdominal sonography showed gallbladder wall thickness and pericholecystic edema. SLE diagnosis with peripheral neuropathy, lupus nephritis, hematological manifestations and ACC was made. Patient was given corticosteroids and cyclophosphamide with good outcome.

Conclusions Only few cases of AAC complicating SLE are reported. Cholecystitis can be an initial manifestation of SLE and reveal the disease or can occur at any time of the disease course. ACC is always associated to other disease manifestations. Patients present with abdominal pain, vomiting and fever. Ultrasonography and computed tomography confirm the diagnosis. The outcome is good with steroids. Sometimes patients are given antibiotics and/or underwent cholecystectomy because of infectious cholecystisis suspicion. None of our patients had surgery.

Disclosure of Interest None declared

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