Acute acalculous cholecystitis as the initial manifestation of systemic lupus erythematous: A case report

Rare case of lupus enteritis presenting as colorectum involvement: A case report and review of literature

BACKGROUND

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can affect the gastrointestinal tract. Most cases of lupus enteritis (LE) involve the small intestine, while the involvement of the whole colon and rectum without the small intestine being affected is extremely rare.

CASE SUMMARY

A 35-year-old woman was diagnosed with colorectal LE after initially presenting with intermittent abdominal pain and vomiting for two months. She had a regular medication history for five years following the diagnosis of SLE but had been irregular in taking medications, which may have contributed to the onset of LE and led to her current hospital admission. According to the 2019 Classification criteria for SLE of the European League Against Rheumatism/American College of Rheumatology, this case scored 14. Additionally, abdominal computed tomography revealed significant wall edema of the colon and rectum, ischemia and hyperemia of the ascending colon intestinal wall, mesenteric vessel engorgement, increased mesangial fat attenuation, ascites, and bilateral ureter-hydronephrosis, all indicative of colon and rectum LE. Laboratory tests also showed lower levels of complement C3 and C4, with an antinuclear antibody titer of 1:100. Overall, it was clear that this case involved the colon and rectum without affecting the small intestine, representing a rare manifestation of SLE. The patient received treatment with 10 mg of methylprednisolone sodium succinate, 100 mL of 0.9% sodium chloride, hydroxychloroquine (100 mg), and nutrition support. After one week of methylprednisolone and hydroxychloroquine therapy, her SLE symptoms and disease activity improved significantly.

CONCLUSION

Although colorectal LE without small intestine involvement is very rare, early diagnosis and excellent management with corticosteroids prevented the need for surgical intervention. Physicians should be aware of colorectal LE without small intestine involvement as a manifestation of lupus flare.

Is conservative management a safe approach for patients with acute acalculous cholecystitis presenting with an acute abdomen?

Patients with acute acalculous cholecystitis (AAC) often present with acute abdominal symptoms. However, recent clinical studies have suggested that some patients with AAC and an acute abdomen, especially when caused by viruses or rheumatic disease, may not require cholecystectomy and that conservative treatment is adequate. Whether cholecystectomy is superior to conservative treatment for patients with AAC presenting with a severe acute abdomen is still uncertain. This was a case series study of AAC-related literature published between 1960 and 2022. In total, 171 cases (104 viral infection-associated AAC and 67 rheumatic disease-associated AAC) were included. The prognoses of patients receiving cholecystectomy or conservative treatment were compared. To account for confounding factors, etiological stratification and logistic regression were performed. The prognosis was similar for patients undergoing cholecystectomy and conservative treatment (P value .364), and virus infection-associated AAC had a better prognosis than rheumatic disease-associated AAC (P value .032). In patients with AAC caused by viruses or rheumatic disease, the acute abdomen can be adequately managed by conservative treatment of the underlying etiology and does not mandate surgical intervention.

Treatment of MDA5-positive dermatomyositis complicated by gangrenous cholecystitis with tofacitinib

Background

Dermatomyositis is a rare idiopathic inflammatory disease with diverse presentations that can have varying degrees of cutaneous and systemic involvement. This phenotypic heterogeneity makes DM a therapeutic challenge. Some therapeutic drugs, such as hormones and immunosuppressants, have poor therapeutic effects. In recent years, tofacitinib has been reported to be effective in the treatment of dermatomyositis.

Case presentation

We report a case of anti-MDA5 antibody-positive dermatomyositis that was relieved after treatment with tofacitinib, during which gallbladder gangrene and suppurative cholecystitis occurred. After cholecystectomy, we continued to use tofacitinib and achieved a good therapeutic effect.

Conclusions

Tofacitinib is effective in the treatment of anti-MDA5 antibody-positive dermatomyositis, but the risk of infection is increased. It can still be used after infection control. Close follow-up should be performed during the use of tofacitinib.