慢性狼瘡腹膜炎與腸炎

Chronic lupus peritonitis and enteritis

A 15-year-old girl presented to our hospital with a four-month history of progressive fullness of abdomen and intermittent abdominal pain. One year ago, she had been diagnosed with systemic lupus erythematosus after presenting with polyarthritis, serositis, high-titer antinuclear antibodies, and elevated anti–double-stranded DNA antibodies. On admission, the physical examination revealed absence of bowel sound, shifting dullness and mild tenderness. A laboratory evaluation showed unremarkable findings except for hypoalbuminemia, hypocomplementemia, and elevated levels of anti–double-stranded DNA antibodies. No significant protein loss was found in urinalysis. There were no evidence of cirrhosis of liver or constrictive pericarditis. Computed tomography of the abdomen revealed massive ascites with centralization of the small intestines (Panel A). Target sign (Panel A, asterisks) and comb’s sign (Panel A, arrows) of the small bowel, indicating intestinal vasculitis, were both present. The ascitic fluid was exudative and cultures were sterile. Steroid pulse therapy (methylprednisolone 1000mg per day) for three days was administered and her symptoms subsided gradually. A follow-up computed tomography of the abdomen after 3 months showed regression of the ascites and intestinal vasculitis (Panel B).