Subacute abdominal pain requiring hospitalization in a systemic lupus erythematosus patient: a retrospective analysis and review of the literature.

In the systemic lupus erythematosus (SLE) patient, abdominal pain is a common problem. Intraabdominal vasculitis must be excluded as the source because of its potentially high mortality rate. We retrospectively reviewed the charts of 56 SLE patients with 75 admissions for predominantly subacute abdominal pain (abdominal pain without peritoneal signs) severe enough to require hospital admission, comparing the diagnostic modalities used, ultimate diagnoses, and use of corticosteroids before admission with 56 age- and sex-matched patients without SLE admitted for abdominal pain during the same time interval. SLE patients were further subdivided by disease activity at presentation using the SELENA SLEDAI score. The in-hospital mortality for all patients in this review was 0%. There were no statistically significant differences in the use of computed tomography between SLE and control patients. Intestinal vasculitis was diagnosed in 5.4% of SLE patients compared with 0% of control patients (P = 0.0433). Only patients with SLEDAI scores >8 developed vasculitis (P < 0.001). We recommend the routine use of computed tomography to diagnose vasculitis only in patients with SLEDAI scores >8 and subacute abdominal pain. All SLE patients with SLEDAI scores <8 and subacute abdominal pain should be evaluated for a cause of abdominal pain other than vasculitis.

Correlation between infection and the onset of the giant cell (temporal) arteritis syndrome. A trigger mechanism?

OBJECTIVE: To assess for a correlation between infection and the onset of the giant cell (temporal) arteritis (GCA) syndrome. METHODS: A matched case-control study design was used. Records of 100 patients with biopsy-proven GCA and 100 patients undergoing corrective surgery for hip fracture who did not have GCA were retrospectively reviewed. Non-GCA patients were sex-matched with GCA patients and were as old or older in age. The review period for GCA patients was up to 4 months before and during the occurrence of symptoms (median 2 months), and for non-GCA patients, it was up to 7 months before hip fracture. The prevalence of infection was compared using matched-pairs odds ratios and their 95% confidence intervals. RESULTS: Infections were 3 times more likely to occur in GCA patients than in non-GCA patients (P < 0.05). CONCLUSION: A correlation between the occurrence of infection and the onset of GCA is strongly suggested. We speculate that infection may act as a trigger mechanism in the pathogenesis of this syndrome.