J Rheum Dis.  2014 Feb;21(1):30-34. 10.4078/jrd.2014.21.1.30.

A Case of Sclerosing Encapsulating Peritonitis Presented with Systemic Lupus Erythematosus

• Bae SC
• Park JH
• Chang HE
• Lee JH
• Kim YS
• Nah JC
• Yoon BY

• KMID: 2222986
• DOI: http://doi.org/10.4078/jrd.2014.21.1.30

Abstract

Sclerosing encapsulating peritonitis (SEP) is characterized by peritoneal fibrosis and adhesion of the peritoneum with the loops of the small intestine. Although the prevalence is low, most cases are caused by peritoneal dialysis, infection, medication, systemic lupus erythematosus (SLE), and intra-abdominal neoplasm. We describe a 22-year old man who was presented with abdominal pain and distension, which were attributed to SLE with peritonitis. He had no specific history of previous medical illness and peritoneal dialysis. He was treated with intravenous high dose methylprednisolone 1 g/day for 3 days, followed by intravenous methylprednisolone 1 mg/kg daily and immunoglobulin. However, his symptoms did not improve. Eventually, a laparoscopic biopsy was performed for an accurate diagnosis. The histopathologic findings were presented in accordance to the typical characteristics of SEP. In spite of medical treatment, he did not show an improvement of clinical symptoms and radiologic findings. As a result, he died from nutritional deficiency, upper gastrointestinal bleeding, and congestive heart failure.

Keyword

Systemic lupus erythematosus; Sclerosing encapsulating peritonitis

MeSH Terms

Abdominal Pain
Biopsy
Diagnosis
Heart Failure
Hemorrhage
Humans
Immunoglobulins
Intestine, Small
Lupus Erythematosus, Systemic*
Malnutrition
Methylprednisolone
Peritoneal Dialysis
Peritoneal Fibrosis
Peritoneum
Peritonitis*
Prevalence
Young Adult
Immunoglobulins
Methylprednisolone

Figure

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  Figure 1. Simple abdomen erect and supine on admission showed centralization of bowel loop, sug-gesting large amount of ascites.

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  Figure 2. Abdominal pelvic CT on admission showed small bowel diffuse wall thickening and centralization with marked ascites (A). On day 21 of therapy, Followup CT scan showed no remarkable changes (B).

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  Figure 3. The peritoneum (A) and greater omentum (B) showed fibrotic change and, fibrotic peritoneum covered small intestine at laparo-tomy.

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  Figure 4. Histopathology in peritoneum (A, H&E stain, ×100) and greater omentum (B, H&E stain, ×200) showed fibrosis and fibroblast hyperproliferation accompanying lymphocyte infiltration.

Reference

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