Two Cases of Lupus Peritonitis

Hiroe Kitahara, Daisuke Komatsu, Masato Kitazawa, Yoshinori Koyama, Shigeyoshi Kumeda and Masako Otani*

Department of Surgery, Nagano Prefectural Kiso Hospital
Department of Pathology, Shinshu University School of Medicine*

We report two cases of lupus peritonitis. Case 1: a 37-year-old woman diagnosed with systemic lupus erythematosus (SLE) at the age of 20, was admitted for abdominal pain and high fever. Appendectomy was done under a diagnosis of acute appendicitis. Because of histopathological findings that the appendix demonstrated inflammatory cell infiltration around the vessel walls, and with immunohematology, a diagnosis of lupus peritonitis was made. Steroid pulse therapy was started and these abdominal findings disappeared. Case 2: a 36-year-old woman, diagnosed with SLE at the age of 23, was admitted for vomiting and diagnosed with ileus. After 2 days, rebound tenderness appeared. Abdominal computed tomography showed marked thickening of the small intestinal walls and increasing ascites, necessitating a laparotomy for suspected strangulated ileus. During surgery, we found a large amount of yellow transparent ascites and serositis-like reddening and swelling of the entire small intestine, resulting in a definitive diagnosis of lupus peritonitis. Treatment with steroids was started and these abdominal findings disappeared. We surgeon have some chance of examining first for acute abdomen, so must keep lupus peritonitis in mind as a probable differential diagnosis for acute abdomen in patients with previous of SLE.

Key words
lupus peritonitis, systemic lupus erythematosus, acute surgical abdomen

Reprint requests
Hiroe Kitahara Department of Surgery, Shinshu University School of Medicine
3-1-1 Asahi, Matsumoto, 390-8621 JAPAN

Accepted
September 27, 2006

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