The two cases of acute acalculous cholecystitis associated with systemic lupus erythematosus (SLE) presented different clinical aspects

Abstract

Case 1. A 23-year-old female with polyarthralgia, facial erythema, pleuritis, carditis, nephropathy and cytopenia, the diagnosis of systemic lupus erythematosus (SLE) was established. She did not have abdominal pain, but abdominal ultrasonography and CT scan demonstrated acute acalculous cholecystitis (AAC) due to SLE. AAC was improved with glucocorticoid therapy. Case 2. A 26-year-old female with cytopenia, anti ds-DNA antibody, low complements, nephropathy and pleuritis, the diagnosis of SLE was established. She was hospitalized due to epigastralgia and high fever, abdominal ultrasonography and CT scan demonstrated pericholecystic edoema without gallstones. AAC was diagnosed and which was thought to be developed in accordance with active SLE. Reports of AAC in patients with SLE are rare and it sometimes difficult to diagnose because the findings of abdominal symptoms or immunological abnormalities are not specific. Because of the high risk of morbidity, surgical intervention remains as mainstay treatment of AAC. Pathophysiology of AAC is still unclear, but present reports of AAC in SLE, its pathology is thought as vasculitis. It is said that there is some possibility of avoiding surgical treatment if we could choose intensive treatment of SLE with glucocorticoid after excluding infections. Here we report 2 cases of AAC associated with SLE and which successfully treated with “non-invasive therapy”. It would be illuminating in clinical practice of treating AAC with SLE.