Bian S N, Yang H H, Wang Q, Xu D, Zhao Y
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2016 Sep 1;55(9):741-4. doi: 10.3760/cma.j.issn.0578-1426.2016.09.020.
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized with multiple organ involvements. Acute acalculous cholecystitis(AAC) is an extremely rare manifestation of digestive system involvement in SLE. We reported a case of 32-year-old woman who complained skin rashes for two weeks and stomachache and oliguria for one day. She had rashes at onset, and developed fever, stomachache, hypotension and headache. Physical examination at admission indicated blood pressure 76/47 mmHg(1 mmHg=0.133 kPa), heart rate 107 beats/min, warm acra. Murphy's sign was positive. Ultrasound suggested the enlarged gallbladder with surrounding hypoecho band yet no biliary calculi were found. A diagnosis of SLE was made, characteristic with distributive shock at the onset and AAC, complicated with neuropsychiatric lupus and lupus nephritis. She had an acute and severe course of disease, which had been relieved after treatment of high dose glucocorticoid and immunosuppressants. This case arouses clinicians to pay more attention to AAC as a rare form of disease flare in SLE. Early diagnosis of AAC is crucial to a favorable prognosis and in avoid of abdominal surgery.
系统性红斑狼疮（SLE）是一种以多器官受累为特征的自身免疫性疾病。急性非结石性胆囊炎（AAC）是SLE消化系统受累的一种极其罕见的表现形式。我们报告了一例32岁女性患者，她主诉皮疹两周，腹痛和少尿一天。发病时即出现皮疹，并逐渐出现发热、腹痛、低血压和头痛。入院时体格检查显示血压76/47 mmHg（1 mmHg = 0.133 kPa），心率107次/分钟，肢端温暖。墨菲氏征阳性。超声检查提示胆囊增大，周围有低回声带，但未发现胆结石。诊断为SLE，起病时伴有分布性休克和AAC，并发神经精神性狼疮和狼疮性肾炎。她的病程急性且严重，经大剂量糖皮质激素和免疫抑制剂治疗后病情缓解。该病例提醒临床医生更多关注AAC作为SLE罕见的疾病发作形式。AAC的早期诊断对于良好预后和避免腹部手术至关重要。
