Jana Soumyajit, Gureh Monika, Cheleng Ankur, Vardhan Ayush
General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND.
Cureus. 2025 Mar 30;17(3):e81479. doi: 10.7759/cureus.81479. eCollection 2025 Mar.
Systemic lupus erythematosus is a complex disease to manage and is complicated further by coexisting comorbidities. We present the case of a 25-year-old female patient who arrived at the emergency department with complaints of abdominal pain for three days, accompanied by a history of fever and non-bilious vomiting for two days. She had no history of trauma or chronic use of painkillers. She was diagnosed with pulmonary and abdominal tuberculosis (TB) four months previously and has been on anti-tubercular therapy since then. Radiological studies showed a collection with echogenic foci in the right iliac fossa with features of abdominal tuberculosis and pneumoperitoneum likely due to perforation. An emergency laparotomy with end ileostomy and distal mucus fistula was performed, followed by limited ileocecal resection, and the specimen was sent for histopathological examination. Surprisingly, the histopathology study revealed SLE vasculitis, contrary to the initial suspicion of ileocecal TB as the cause of perforation peritonitis. The patient was discharged and was followed up within a week with normal stomal function.
系统性红斑狼疮是一种难以管理的复杂疾病，并存的合并症使其病情更加复杂。我们报告一例25岁女性患者，因腹痛3天到急诊科就诊，伴有发热和非胆汁性呕吐2天的病史。她没有外伤史或长期使用止痛药的历史。四个月前她被诊断为肺结核和腹部结核，此后一直在接受抗结核治疗。影像学检查显示右髂窝有一个伴有回声灶的积液，具有腹部结核的特征和气腹，可能是由于穿孔所致。进行了急诊剖腹探查术，行末端回肠造口术和远端黏液瘘，随后进行了有限的回盲部切除术，并将标本送去做组织病理学检查。令人惊讶的是，组织病理学研究显示为系统性红斑狼疮血管炎，与最初怀疑回盲部结核是腹膜炎穿孔的原因相反。患者出院，一周内进行随访，造口功能正常。
