Huang Szu-Cheng, Chan Yi-Ling, Cheng Hao-Tsai, Goh Zhong Ning Leonard, Wong Yon-Cheong, Seak Chen-Ken, Seak Joanna Chen-Yeen, Li Chih-Huang, Chen Hsien-Yi, Seak Chen-June
Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
Diagnostics (Basel). 2022 Oct 27;12(11):2605. doi: 10.3390/diagnostics12112605.
Systemic lupus erythematosus (SLE) is a chronic, multi-organ autoimmune disease which rarely presents with peritoneal involvement. As such, its diagnosis in the emergency department (ED) based on a clinical presentation of gastrointestinal symptoms is extremely challenging. Yet, reaching such a diagnosis in the ED is crucial for avoiding unnecessary surgical intervention and initiating early glucocorticoid therapy to maximise patient outcomes. Here, we report a case of newly diagnosed SLE in a 28-year-old lady who presented atypically and unusually with abdominal pain and ascites. She required extensive but methodical investigations, and was eventually diagnosed with lupus mesenteric vasculitis with underlying newly diagnosed SLE in the ED. The patient was promptly treated with methylprednisolone resulting in marked clinical improvement. Emergency physicians should be mindful of abdominal pain with ascites as an extremely rare but important clinical presentation of SLE. Early diagnosis and commencement of glucocorticoid therapy in these patients are crucial in halting disease progression and averting the need for surgical intervention.
系统性红斑狼疮（SLE）是一种慢性多器官自身免疫性疾病，很少出现腹膜受累情况。因此，基于胃肠道症状的临床表现，在急诊科（ED）对其进行诊断极具挑战性。然而，在急诊科做出这样的诊断对于避免不必要的手术干预以及尽早开始糖皮质激素治疗以最大化患者治疗效果至关重要。在此，我们报告一例28岁女性新诊断为SLE的病例，该患者以腹痛和腹水的非典型及罕见表现就诊。她需要进行广泛但有条不紊的检查，最终在急诊科被诊断为狼疮性肠系膜血管炎，基础疾病为新诊断的SLE。患者立即接受甲泼尼龙治疗，临床症状显著改善。急诊医生应注意腹痛伴腹水是SLE一种极其罕见但重要的临床表现。对这些患者进行早期诊断并开始糖皮质激素治疗对于阻止疾病进展和避免手术干预的必要性至关重要。
