title: Chronic lupus peritonitis is characterized by the ascites with a large content of interleukin-6.
abstract: Systemic lupus erythematosus (SLE) is an autoimmune disease and can cause multi-organ damage. Peritoneal involvement, also called lupus peritonitis, is a rare but sometimes fatal manifestation. Deposition of immune complexes consisting of immunoglobulin G and complement is considered to be involved in the pathogenesis of lupus peritonitis; however, it remains unknown whether inflammatory cytokines contribute to the pathology of this manifestation. Here we present two patients with treatment-resistant lupus peritonitis: a 37-year-old woman with a 26-year history of SLE who had been treated with prednisolone and cyclophosphamide followed by azathioprine and a 65-year-old woman with a 33-year history of SLE who had been treated with prednisolone alone. Both patients were admitted to our department because of abdominal distention. Computed tomography scans showed massive ascites. Ascitic fluid examinations of both patients showed leukocytosis with no evidence of malignancy or infection. After eliminating other causes for ascites, they were diagnosed with lupus peritonitis. Despite the intensified immunosuppressive therapy, they died of uncontrolled peritonitis several months after admission. Examinations of the ascites at admission also revealed a large content of interleukin (IL)-6, compared with other inflammatory cytokines, IL-1β and tumor necrosis factor-α. In fact, the ascitic IL-6 levels of these two patients were 12,389 pg/mL and 5,486 pg/mL, much higher than their serum IL-6 levels of 36 pg/mL and 140 pg/mL, respectively. We therefore suggest that IL-6 may contribute to the pathogenesis of lupus peritonitis and that the inhibition of IL-6 signaling may provide a novel therapeutic strategy for lupus peritonitis.
authors: Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine.
authors: Ryu
authors: R
authors: Watanabe
authors: Hiroshi
authors: H
authors: Fujii
authors: Yukiko
authors: Y
authors: Kamogawa
authors: Kyohei
authors: K
authors: Nakamura
authors: Tsuyoshi
authors: T
authors: Shirai
authors: Tomonori
authors: T
authors: Ishii
authors: Hideo
authors: H
authors: Harigae
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000150:complications* / Q000000981:diagnostic imaging; D002908:Chronic Disease; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D010538:Peritonitis / Q000150:complications* / Q000000981:diagnostic imaging; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6