Acalculous ischemic gallbladder necrosis in the catastrophic antiphospholipid syndrome.
A 29-year-old woman was referred for abdominal pain. Results of tests for lupus anticoagulant and antibodies to phosphatidylserine and to beta2-glycoprotein I were positive, but the patient had no features of systemic lupus erythematosus (SLE). Abdominal ultrasonography showed a thickening of the gallbladder wall without cholelithiasis. A surgical procedure revealed necrotic areas of the gallbladder wall, and a cholecystectomy was performed. Histologic examination of the gallbladder showed multiple thrombi and no vasculitis. Despite full-dose heparin, the patient developed a catastrophic antiphospholipid syndrome (APS) and subsequently died. Among connective tissue disorders, acute acalculous cholecystitis has been reported in patients with polyarteritis nodosa and/or SLE. APS should be considered as a possible cause of acalculous cholecystitis.
Desailloud
R
R
Centre Hospitalier de Valenciennes, France.
Dessailloud
R
R
Papo
T
T
Vaneecloo
S
S
Gamblin
C
C
Vanhille
P
P
Piette
J C
JC
D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000473:pathology; D002764:Cholecystitis / Q000150:complications / Q000473:pathology; D002769:Cholelithiasis / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D005704:Gallbladder / Q000098:blood supply* / Q000473:pathology*; D006801:Humans; D007511:Ischemia / Q000150:complications*; D009336:Necrosis