When a Rapid Accurate Diagnosis Changes Therapeutic Approach: Recognizing Acute Abdominal Pain with Ascites as a Possible Presentation of Systemic Lupus Erythematosus

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.

Value of ascitic fluid cholesterol and serum-ascites albumin gradient in differentiating cirrhotic and malignancy related ascites

In a perspective study, the ascitic fluid and serum concentration of total cholesterol, total proteins and albumin in a group of 45 patients was studied. Patients with nonmalignant or cirrhotic ascites were compared with patients having malignancy related ascites and it was proved that the ascitic fluid cholesterol and the serum ascites albumin gradient helped to differentiate cirrhotic from malignant ascites. These two parameters showed a remarkable relationship to the presence/absence of malignancy. Non malignant ascites patients had ascitic fluid cholesterol values of 19.41±8.33 mg/dl, as against the malignancy related ascites patients, who showed levels of 95.87±1.24 mg/dl. Similarly, the serum-ascites albumin gradient levels were 2.89±0.65 in non malignant ascites patients, while the malignancy related ascites cases had 0.86±0.50. The discrimination values for cholesterol were taken as 45 mg/dl while that for serum ascites gradient was taken as 1.1. Levels of serum cholesterol, total protein and albumin were not significantly altered.