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Autoimmune Peritonitis

This document summarizes a rare case of autoimmune peritonitis as the initial manifestation of systemic lupus erythematosus (SLE) in a 36-year old female patient. She presented with severe abdominal pain, vomiting, and constipation. Testing showed ascites, pleural effusion, and proteinuria. Autoimmune markers were strongly positive, leading to a diagnosis of SLE and autoimmune peritonitis. Treatment with IV steroids and later oral prednisolone improved her symptoms and she was discharged in a stable condition. This case illustrates that lupus peritonitis as the initial presentation of SLE is uncommon and requires extensive evaluation to rule out other causes of ascites. Prognosis is usually

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22 views1 page

Autoimmune Peritonitis

This document summarizes a rare case of autoimmune peritonitis as the initial manifestation of systemic lupus erythematosus (SLE) in a 36-year old female patient. She presented with severe abdominal pain, vomiting, and constipation. Testing showed ascites, pleural effusion, and proteinuria. Autoimmune markers were strongly positive, leading to a diagnosis of SLE and autoimmune peritonitis. Treatment with IV steroids and later oral prednisolone improved her symptoms and she was discharged in a stable condition. This case illustrates that lupus peritonitis as the initial presentation of SLE is uncommon and requires extensive evaluation to rule out other causes of ascites. Prognosis is usually

Uploaded by

karanleha
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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RARE CASE OF AUTOIMMUNE PERITONITIS

Dr. Anmol Raj Gupta,

1st year FNB Minimal Access Surgery Resident,

Department of Surgical Gastroenterology, MMHRC, Madurai, Tamilnadu

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, characterized by


autoantibodies against nuclear antigens and deposition of immune complexes in several tissues.
Approximately 16% of SLE patients have pleuritis and pericarditis, but peritoneal involvement is
extremely rare, and SLE with peritonitis as the first manifestation is an even rarer condition.

A 36 year old female presented with severe diffuse abdominal pain, vomiting and constipation
since 10 days. H/o polyarthralgia since past 4 months. She had no joint swelling, early morning
stiffness or fever. No history of oral ulcers, photosensitivity , malar rash, frothy urine or bleeding
tendencies. Blood investigations showed normal total count, platelet count, RFT , LFT, no
coagulopathy, low protein and albumin levels. Serum amylase, lipase normal. Urine routine
showed trace proteinuria. Serum procalcitonin normal. CT abdomen- gross ascites, bilateral
pleural effusion, normal liver, submucosal edema of colon and ileal loops, no mass, no intestinal
obstruction. Ascitic fluid analysis showed low SAAG high protein non-inflammatory ascites,
with low ADA and cytology negative for malignant cells. Considering her past history of joint
pains, nephritic range proteinuria, we considered possible autoimmune peritonitis. Hence ANA
and ds DNA was sent which were strongly positive. Based on these findings diagnosed as SLE
and autoimmune peritonitis. She was initiated on IV steroids and later changed to oral
prednisolone 1 mg/kg. The patient improved, abdomen distension subsided, no further vomiting
and patient discharged in stable condition.

This case illustrates that lupus peritonitis as the initial SLE manifestation is rare. Lupus
peritonitis should be considered an exclusion diagnosis, requiring extensive clinical evaluation in
search for alternative causes of exudative ascites. Prognosis is usually good, and treatment is
based on the use of corticosteroids, with good response.

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