Acute acalculous cholecystitis in systemic lupus erythematosus: a rare initial manifestation

Manuel, Valdano; Pedro, Gertrudes Maria; Cordeiro, Lemuel Bornelli; Miranda, Sandra Maria da Rocha Neto de

doi:10.1016/j.rbre.2014.03.027

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Case reports • Rev. Bras. Reumatol. 56 (2) • Mar-Apr 2016 • https://doi.org/10.1016/j.rbre.2014.03.027 copy

Acute acalculous cholecystitis in systemic lupus erythematosus: a rare initial manifestation^☆ ☆ The study was originated at Clínica Girassol, Luanda, Angola.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Acute acalculous cholecystitis is a very rare gastrointestinal manifestation in systemic lupus erythematosus and becomes rarer as an initial manifestation. There are only two cases reported. The authors report a 20-year-old black woman that presented acute acalculous cholecystitis revealed by abdominal computed tomography. During hospitalization, she was diagnosed systemic lupus erythematosus. Conservative treatment with antibiotics was performed with complete remission of the symptoms. Corticosteroid was started in ambulatory. Cholecystectomy has been the treatment of choice in acute acalculous cholecystitis as a complication of systemic lupus erythematosus. The patient responded well to conservative treatment, and surgery was not required. This case is unique in the way that corticosteroid was started in ambulatory care. We should not forget that the acute acalculous cholecystitis can be the initial presentation of systemic lupus erythematosus although its occurrence is very rare. Conservative treatment should be considered. Abdominal computed tomography was a determinant exam for better assessment of acute acalculous cholecystitis.

Keywords:
Systemic lupus erythematosus; Acute acalculous cholecystitis; Abdominal computed tomography; Abdominal computed tomographyInitial

Exam	Results	Reference values
Test for Plasmodium	Negative	Negative
Hemoglobin	6.9 g/dL	11.5–15.5
Leukocytes	3.2 × 10⁹/L	04–11
Platelets	342 × 10⁹/L	150–400
Total proteins	5.2 mg/dL	6.5–8.1
Proteinuria-24 h	174 mg/dia	<150
Albumin	2.3 mg/dL	3.5–5.0
ALT	80 U/L	<40
AST	112 U/L	<40
LDH	1557 U/L	230–460
Alkaline phosphatase	155 U/L	32–92
GGT	256 U/L	<50
Creatinine	0.4 mg/dL	0.6–1.3
Urea	4 mg/dL	0.8–26
Amylase	28 U/L	36–128
Anti-HBs	0.44 S/CO	<0.90
Anti-HCV	0.8 S/CO	<0.9
Toxoplasmosis	0.2 S/CO	<0.8
ANA^a a Tested in pathology laboratory support services – AMPATH.	6 IU/mL	>1.1 positive
Anti-dsDNA^a a Tested in pathology laboratory support services – AMPATH.	80 IU/mL	>60 positive
C3^a a Tested in pathology laboratory support services – AMPATH.	45.2 mg/dL	79–152
C4^a a Tested in pathology laboratory support services – AMPATH.	7.1 mg/dL	16–38
Anticardiolipin IgM^a a Tested in pathology laboratory support services – AMPATH.	7.9 U MPL/mL	0.0–7.0
Anti-β2 glycoprotein 1 IgM^a a Tested in pathology laboratory support services – AMPATH.	12.1 U MPL/mL	0.0–5.0
Anti-β2 glycoprotein 1 IgG^a a Tested in pathology laboratory support services – AMPATH.	5.5 U GPL/mL	0.0–5.0
Smooth muscle antibody^a a Tested in pathology laboratory support services – AMPATH.	1:80	<1:20

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[1] *Corresponding author. E-mail: valdanympub@gmail.com (V. Manuel).

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Acute acalculous cholecystitis in systemic lupus erythematosus: a rare initial manifestation☆ ☆ The study was originated at Clínica Girassol, Luanda, Angola.

ABSTRACT

Acute acalculous cholecystitis in systemic lupus erythematosus: a rare initial manifestation^☆ ☆ The study was originated at Clínica Girassol, Luanda, Angola.