title: [The 452th case: rash, hypotension, abdominal pain and headache].
abstract: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized with multiple organ involvements. Acute acalculous cholecystitis(AAC) is an extremely rare manifestation of digestive system involvement in SLE. We reported a case of 32-year-old woman who complained skin rashes for two weeks and stomachache and oliguria for one day. She had rashes at onset, and developed fever, stomachache, hypotension and headache. Physical examination at admission indicated blood pressure 76/47 mmHg(1 mmHg=0.133 kPa), heart rate 107 beats/min, warm acra. Murphy's sign was positive. Ultrasound suggested the enlarged gallbladder with surrounding hypoecho band yet no biliary calculi were found. A diagnosis of SLE was made, characteristic with distributive shock at the onset and AAC, complicated with neuropsychiatric lupus and lupus nephritis. She had an acute and severe course of disease, which had been relieved after treatment of high dose glucocorticoid and immunosuppressants. This case arouses clinicians to pay more attention to AAC as a rare form of disease flare in SLE. Early diagnosis of AAC is crucial to a favorable prognosis and in avoid of abdominal surgery.
authors: Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China.
authors: S N
authors: SN
authors: Bian
authors: H H
authors: HH
authors: Yang
authors: Q
authors: Q
authors: Wang
authors: D
authors: D
authors: Xu
authors: Y
authors: Y
authors: Zhao
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D005076:Exanthema / Q000209:etiology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006261:Headache / Q000209:etiology*; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy; D008181:Lupus Nephritis / Q000188:drug therapy / Q000209:etiology; D020945:Lupus Vasculitis, Central Nervous System / Q000188:drug therapy / Q000209:etiology; D011379:Prognosis; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents