Undetected intraabdominal sepsis due to prolonged corticosteroid therapy in systemic lupus erythematosus: a case report and literature review | [Anaesthesia, Pain and Intensive Care • 2024]

Author(s):

1. Yosephine Ervina Leman: Department of Anesthesia & Intensive Care, Faculty of Medicine, Univeristas Indonesia, Jakarta, 10430, Indonesia

2. Vera Irawany: Jl. RS. Fatmawati Raya, Cilandak Barat, Cilandak, Jakarta Selatan 12430. Indonesia;

3. Sidharta Kusuma Manggala: Department of Anesthesia & Intensive Care, Faculty of Medicine, Univeristas Indonesia, Jakarta, 10430, Indonesia

Abstract:

Gastrointestinal manifestations are not included in the criteria for diagnosing systemic lupus erythematosus (SLE) by the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) 2019, however, gastrointestinal disorders are one of the potentially fatal complications of SLE. Mesenteric vasculitis and thrombosis are the two main mechanisms that cause gastrointestinal disorders in SLE patients. Long-term immunosuppressants used by SLE patients might alter the immune system's response to infection, leading to immunoparalysis. The delay in recognizing might cause sepsis, thus increasing the mortality risk. A 47-year-old woman with a history of SLE complained of hematochezia. The patient had been consistently consuming 12 mg of methylprednisolone every day for the past five years without doctor's supervision. Past medical history of congestive heart failure (CHF) caused by coronary arterial disease (CAD). After 24 days hospitalized for observation of hematochezia, an emergency laparotomy was performed due to deterioration caused by peritonitis. Intraoperative, 60 cm of jejunal necrosis was identified and intestinal resection was done. The patient's condition improved in two days after emergency laparotomy and intensive treatment. The undetected intraabdominal sepsis caused by jejunal infarction and gut necrosis due to long-term use of corticosteroid that masked the manifestations of severe infection in the gastrointestinal tract infarction and necrosis. Abbreviations: NLR - neutrophil to lymphocyte ratio; SGOT - serum glutamic oxaloacetic transminase; SGPT - serum glutamic pyruvic transminase; eGFR - estimated glomerular filtration rate; PT - prothrombin time; APTT - activated partial thromboplastin time; INR - international normalized ratio

Page(s): 765-771

DOI: 10.35975/apic.v28i4.2525

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 28, Issue: 4, Year: 2024

Keywords:

Corticosteroid , Intraabdominal sepsis , Systemic lupus erythematosus , Immunoparalysis

References:

[1] Gu Y,Zhu T,Wang Y,Xu H Y . .Systemic lupus erythematosus with intestinal perforation: a case report.. , : .

[2] Wu Z,Ruan C,Li F,Peng Z,Wang X,P. X .2015 .A case of systemic lupus erythematosus with rectal necrosis. Lupus., 10(3) : 1234-8.

[3] -y Aringer M,Costenbader K,Daikh D,Brinks R,Mosca M,Ramsey-Goldman R .2019 .European league against rheumatism/American college of rheumatology classification criteria for systemic lupus erythematosus. J Intensive Care, 8(1) : 3-9.

[4] Rheumatol Arthritis,Tian XP,Zhang X .2019 .Gastrointestinal involvement in systemic lupus erythematosus: insight into pathogenesis, diagnosis, and treatment. World J Gastroenterol., 71(9) : 1400-12.

[5] Fernandes ABS,Zin WA,Rocco PRM . .Corticosteroids in acute respiratory distress syndrome. Braz J Med Biol Res., 10 : .

[6] .2005 .Critical illness stress-induced immune suppression. In: La Revue du praticien; 2007, 38(2) : 217-28.

[7] Niu M,Chen P,Kalil AC,Opal SM .2021 .Sepsis in the severely immunocompromised patient. Curr Infect Dis Rep., 9 : 10.

[8] .2015 .. , 17(6) : 487.

Citations

Citations are not available for this document.

Citations

Downloads

Views