Differences in disease features between childhood-onset and adult-onset systemic lupus erythematosus patients presenting with acute abdominal pain.
OBJECTIVE
Abdominal pain in systemic lupus erythematosus (SLE) patients has rarely been analyzed in pediatric populations. We planned to investigate the potential differences between childhood-onset and adult-onset SLE patients who were hospitalized because of acute abdominal pain.


METHODS
A retrospective study including 23 childhood-onset SLE patients with 38 admissions and 88 adult-onset SLE patients with 108 admissions from 1999 to 2008 were conducted in our hospital. All of them had the chief complaint of diffuse abdominal pain.


RESULTS
The etiologies of acute abdominal pain in adult-onset SLE patients were more diverse than childhood-onset SLE patients. The most common cause of acute abdominal pain in SLE patients was lupus mesenteric vasculitis (LMV) (18.5%), followed by acute gastroenteritis (14.4%), pancreatitis (10.3%), appendicitis (7.5%), and cholecystitis (6.2%). Compared with adults, children were admitted more often due to LMV (31.6% versus 13.9%; P = 0.016), had more frequently recurrent episodes (39.1% versus 14.8%; P = 0.009), and were more often treated with immunosuppressive agents (31.6% versus 7.4%; P < 0.001) at the time of admission. The overall case fatality rate of acute abdomen in SLE patients was 9.4%. The extra-gastrointestinal symptoms, laboratory evaluation, disease activity, and organ damage measured by the SLE Disease Activity Index and outcomes were comparable between children and adults.


CONCLUSIONS
Various etiologies of acute abdominal pain should be considered in SLE patients. LMV is the most common cause of acute abdomen in childhood-onset SLE patients with low mortality and morbidity provided by prompt diagnosis and timely administration of high-dose intravenous corticosteroids after excluding real surgical abdomen.
Tu
Yu-Ling
YL
Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Yeh
Kuo-Wei
KW
Chen
Li-Chen
LC
Yao
Tsung-Chieh
TC
Ou
Liang-Shiou
LS
Lee
Wen-I
WI
Huang
Jing-Long
JL
D015746:Abdominal Pain / Q000188:drug therapy / Q000209:etiology*; D000208:Acute Disease; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D002648:Child; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications; D012189:Retrospective Studies; D014657:Vasculitis / Q000150:complications; D055815:Young Adult
D000305:Adrenal Cortex Hormones