Category Archives: Abdominal pain

Abdominal pain as the presenting feature of systemic lupus erythematosus (Part 2)

The chest x-ray revealed small bilateral pleural effusions. An ultrasound of the abdomen revealed diffuse small bowel thickening and moderate ascites. A computed tomography of the abdomen (Figure 1) confirmed these findings. Upper gastrointestinal endoscopy was normal and the biopsy of the jejunum (Figure 2) revealed a nonspecific inflammatory infiltrate. Colonoscopy and biopsies of the colon and terminal ileum did not reveal any abnormalities. Echocardiography was unremarkable. A mesenteric angiogram was performed that did not show any evidence of vasculitis on selective celiac, superior mesenteric and bilateral renal selections. Continue reading

Abdominal pain as the presenting feature of systemic lupus erythematosus: DISCUSSION (Part 2)

clinically mild ascites, small pleural effusions and hypoalbuminemiaInterestingly, the patient also presented with clinically mild ascites, small pleural effusions and hypoalbuminemia. Although she did have a suggestion of proteinuria on an initial urinalysis, subsequent urinalysis failed to demonstrate an ongoing renal protein loss. Therefore, we feel that in light of the bowel wall thickening and the hypoalbuminemia that there was also an SLE-associated protein-losing enteropathy (PLE). Continue reading

Abdominal pain as the presenting feature of systemic lupus erythematosus: DISCUSSION (Part 1)

SLE is a common disorder that affects one in 2500 people, with a female predominance. The classification (but not clinical diagnosis) of SLE is typically based on the 1982 revised criteria of the American Rheumatologic Associaton (ARA) for the classification of SLE (3), which is reported to be 96% sensitive and 96% specific. The ARA critieria require a serial or simultaneous presentation of four of 11 listed symptoms, signs or laboratory findings for a diagnosis of lupus. Continue reading

Abdominal pain as the presenting feature of systemic lupus erythematosus (Part 1)

Chronic Abdominal PainAbdominal 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). Continue reading