RESUMEN
Acute acalculous cholecystitis is a very rare gastrointestinal manifestation in systemic lupus erythematosus and becomes rarer as an initial manifestation. There are only two cases reported. The authors report a 20-year-old black woman that presented acute acalculous cholecystitis revealed by abdominal computed tomography. During hospitalization, she was diagnosed systemic lupus erythematosus. Conservative treatment with antibiotics was performed with complete remission of the symptoms. Corticosteroid was started in ambulatory. Cholecystectomy has been the treatment of choice in acute acalculous cholecystitis as a complication of systemic lupus erythematosus. The patient responded well to conservative treatment, and surgery was not required. This case is unique in the way that corticosteroid was started in ambulatory care. We should not forget that the acute acalculous cholecystitis can be the initial presentation of systemic lupus erythematosus although its occurrence is very rare. Conservative treatment should be considered. Abdominal computed tomography was a determinant exam for better assessment of acute acalculous cholecystitis.
Asunto(s)
Colecistitis Alitiásica/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Tratamiento Conservador , Femenino , Humanos , Resultado del Tratamiento , Adulto JovenRESUMEN
ABSTRACT Acute acalculous cholecystitis is a very rare gastrointestinal manifestation in systemic lupus erythematosus and becomes rarer as an initial manifestation. There are only two cases reported. The authors report a 20-year-old black woman that presented acute acalculous cholecystitis revealed by abdominal computed tomography. During hospitalization, she was diagnosed systemic lupus erythematosus. Conservative treatment with antibiotics was performed with complete remission of the symptoms. Corticosteroid was started in ambulatory. Cholecystectomy has been the treatment of choice in acute acalculous cholecystitis as a complication of systemic lupus erythematosus. The patient responded well to conservative treatment, and surgery was not required. This case is unique in the way that corticosteroid was started in ambulatory care. We should not forget that the acute acalculous cholecystitis can be the initial presentation of systemic lupus erythematosus although its occurrence is very rare. Conservative treatment should be considered. Abdominal computed tomography was a determinant exam for better assessment of acute acalculous cholecystitis.
RESUMO A colecistite aguda acalculosa é uma manifestação gastrointestinal rara no lúpus eritematoso sistêmico e ainda mais rara como manifestação inicial. Foram descritos apenas dois casos até o momento. Os autores relatam o caso de uma mulher negra de 20 anos, com quadro de colecistite aguda acalculosa revelada pela tomografia computadorizada do abdome. Durante a hospitalização, a paciente foi diagnosticada com lúpus eritematoso sistêmico. Houve remissão completa dos sintomas após tratamento conservador com antibióticos. Iniciou-se tratamento com corticosteroides no ambulatório. Embora a colecistectomia seja o tratamento de escolha em casos de colecistite aguda acalculosa como complicação do lúpus eritematoso sistêmico, a paciente respondeu bem ao tratamento conservador; logo, a cirurgia não foi necessária. Este caso é único em razão do modo como o corticosteroide foi iniciado no atendimento ambulatorial. É importante lembrar que a colecistite aguda acalculosa pode ser a manifestação inicial do lúpus eritematoso sistêmico, embora sua ocorrência seja rara. Deve-se considerar a realização de tratamento conservador. A tomografia computadorizada do abdome foi determinante para que fosse feita uma melhor avaliação dacolecistite aguda acalculosa.
Asunto(s)
Humanos , Femenino , Adulto Joven , Colecistitis Alitiásica/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Resultado del Tratamiento , Corticoesteroides/uso terapéutico , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/tratamiento farmacológico , Tratamiento ConservadorRESUMEN
A colecistite alitiásica aguda (CAA) trata-se de uma inflamação da vesícula biliar sem a evidência de cálculos biliares. É estimado que ocorra em 2-15% de todos os casos de colecistite aguda e geralmente se associa a condições de saúde críticas, como pós-operatório, trauma recente grave e queimaduras. A etiologia da CAA é multifatorial e sua patofisiologia ainda permanece pouco compreendida. Os principais mecanismos de doença propostos incluem lesão por isquemia-reperfusão, resposta inflamatória sistêmica e estase biliar. O diagnóstico, que costuma ser difícil, é baseado em dados clínicos, laboratoriais, radiológicos e peroperatórios. As manifestações costumam ser inespecíficas, tais como dor em quadrante superior direito, febre, náusea, vômitos, icterícia, leucocitose e função hepática alterada. Os achados de imagem na ultrassonografia (US) e tomografia computadorizada (TC) incluem aumento da espessura da parede e do volume da vesícula biliar, barro biliar, fluido pericolecístico e presença de gás intramural. A combinação de pelo menos três desses achados é necessária para o diagnóstico de CAA. A sensibilidade e especificidade dos métodos de imagem são variáveis, entretanto, considera-se que a TC é superior à US. O tratamento de escolha é colecistectomia, com crescente preferência para utilização da via percutânea. O tratamento clínico associado inclui melhora dos parâmetros hemodinâmicos com drogas vasoativas e medicamentos antimicrobianos. A taxa de mortalidade costuma ser alta (10-67%), independentemente do tratamento instituído. Tal fato é atribuído às condições mórbidas pré-existentes que costumam acompanhar o quadro e contribuem para a rápida progressão da doença para gangrena e perfuração. (AU)
Acalculous cholecystitis (AC) is an acute infiamatory disease of the gallbladder without the evidence of biliary stones. It accounts for 2-15% of all cases of acute cholecystitis and is generally associated with critically ill patients, post-operatory, recente trauma and burns. AC etiology is multifactorial and still obscure. The main mechanisms include ischemia/ reperfusion lesions, systemic infiamatory reaction and biliary stasis. The diagnosis may be difficult, being based on clinical, labaratorial, radiographic and peroperatory features. Clinical manifestations, although inespefics, are right hypochondrial pain, fever, nausea, vomit, jaundice, leukocytosis and high liver enzymes. Ultrasound and tomography aspects are thickening of the gallbladder wall with pericholecystic fluid, biliary sludge and emphysematous cholecystitis. The combination of three or more of those aspects is necessary to confirm the diagnosis of AC. The sensibility and specificity of the radiological exams are insconstant, but the tomography is considered superior to ultrasound. The definitive therapy is cholecystectomy. Associated clinical approach include the use of vasoactive drugs and antibiotics. Mortality is high (10-67%), mainly because of the comobidity diseases. (AU)
Asunto(s)
Humanos , Colecistitis Alitiásica/diagnóstico por imagen , Colecistectomía Laparoscópica , Colecistitis Alitiásica/cirugía , Colecistitis Alitiásica/tratamiento farmacológico , Vesícula Biliar/fisiopatologíaRESUMEN
Small- and medium-vessel vasculitis is a common manifestation in systemic lupus erythematosus (SLE) and may occur in any organ. However, acute acalculous cholecystitis is a rare abdominal manifestation in SLE, especially in children. We report a case of a 12-year-old patient who initially presented with AAC and seizure. Follow-up investigation diagnosed SLE, and brain magnetic resonance imaging had hyperintense white matter lesions in cortico-subcortical regions. The patient was successfully treated with pulse methylprednisolone and cyclophosphamide without surgical intervention.
Asunto(s)
Colecistitis Alitiásica/etiología , Lupus Eritematoso Sistémico/complicaciones , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/tratamiento farmacológico , Enfermedad Aguda , Niño , Ciclofosfamida/administración & dosificación , Diagnóstico Diferencial , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Glucocorticoides/administración & dosificación , Humanos , Inmunosupresores/administración & dosificación , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Imagen por Resonancia Magnética , Metilprednisolona/administración & dosificaciónRESUMEN
Acalculous cholecystitis has been associated with several infectious agents, but its relation with Plasmodium falciparum infection has not been clearly defined. This is the first case of acalculous cholecystitis produced by Plasmodium falciparum infection that is directly documented and should be included among the differential diagnoses of acalculous cholecystitis.
Asunto(s)
Colecistitis Alitiásica/parasitología , Malaria Falciparum/complicaciones , Plasmodium falciparum/aislamiento & purificación , Colecistitis Alitiásica/complicaciones , Colecistitis Alitiásica/diagnóstico por imagen , Colecistitis Alitiásica/tratamiento farmacológico , Adulto , Animales , Antimaláricos/uso terapéutico , Diagnóstico Diferencial , República Dominicana , Doxiciclina/uso terapéutico , Femenino , Humanos , Malaria Falciparum/tratamiento farmacológico , Malaria Falciparum/parasitología , Quinina/uso terapéutico , Viaje , UltrasonografíaRESUMEN
A 62-year-old woman was treated with sunitinib as a second-line therapy for metastatic clear-cell renal carcinoma. She was given oral sunitinib 50 mg once daily, 4 weeks on followed by 2 week off. During the fourth week of her first cycle, the patient was admitted to our hospital because of an acute-onset, right upper quadrant pain associated with nausea and vomiting. She was diagnosed with acute acalculous cholecystitis, which was treated with broad-spectrum antibiotics, and sunitinib therapy was discontinued. A follow-up computed tomography scan of the abdomen revealed a complete resolution of gallbladder changes. Our patient did not have major risk factors for developing an acalculous cholecystitis except for a relative immunosuppressed state secondary to her advanced renal cancer. The Naranjo Adverse Drug Reaction Probability Scale score for this event was 5, indicating a probable association of the event with sunitinib. Because the use of sunitinib is expanding in clinical practice, we want to alert the oncology community about this uncommon and life-threatening complication in patients receiving sunitinib or another agent with antiangiogenic activity.