Abdominal pain is a very common medical complaint, and accounts for a significant number of primary care physician visits and referrals to gastroenterologists. In one survey, 21.8% of respondents reported abdominal pain in the preceding one month, and more than 65% rated the symptoms as either moderate or severe. We report a case of a patient who presented with severe abdominal pain that was the initial clinical manifestation of occult systemic lupus erythematosus (SLE).
A previously healthy 26-year-old Japanese woman presented with diffuse, colicky central abdominal pain, a four-week history of frequent nonbloody, soft stools, a two-week history of anorexia and fatigue and a three-day history of fever, nausea and vomiting. Movement aggravated her pain and there were no relieving factors. There was no melena, bloody diarrhea, night sweats, arthralgias, skin rashes, photosensitivity, headaches, visual disturbances, dyspnea, chest pain, Raynaud’s phenomena, sicca symptoms or changes to her bladder habits. She did note a 2.3 kg weight loss over the past three months. Medications before presentation included oral contraceptives and occasional ibuprofen or acetaminophen. She did not smoke or consume alcohol and the family history was unremarkable. On examination, she was afebrile. Head, neck and cardiopulmonary examinations were unremarkable. The abdomen was soft but tender over the epigastrum without rebound. There was no stigmata of chronic liver disease, hepatosplenomegaly, masses or significant distention. A rheumatological examination revealed no abnormalities and a dermatological survey was unremarkable. Cheapest medications online – cialis professional 20 mg for you to get healthy very soon.
Laboratory investigations revealed a leukocyte count of 6.1×109/L with a decreased lymphocyte count of 0.5×109/L (normal range: 1.2-3.0×109/L ), hemoglobin 139 g/L, and platelet count of 208×109/L. Serum electrolytes revealed a mild hypokalemia of 3.4 mmol/L (normal range 3.5-5.0 mmol/L), urea 3.8 mmol/L and serum creatinine was 68 pmol/L. Serum amylase and liver enzymes were normal. The serum albumin was decreased at 27 g/L (normal range 34 to 50 g/L). Routine urinalysis initially revealed trace proteins on dipstick but was negative on repeated urinalysis. Stool cultures and hepatitis A, B and C serology were negative.