Ceftriaxone was administrated for the patient

Ceftriaxone was administrated for the patient. missed abortion, it is better to perform CC-401 anti-nuclear antibody (ANA) and anticardiolipin antibody assessments as a preventive method for early diagnosis and early treatment. strong class=”kwd-title” Keywords: Hepatitis, Systemic lupus erythematosus, Hepatic necrosis INTRODUCTION Lupus is an autoimmune disease characterized by acute and CC-401 chronic inflammation of various tissues of the body. Any part of the gastrointestinal (GI) tract and the hepatobiliary system can be involved. Liver disease in systemic lupus erythematosus (SLE) has been reported in 8 to 23% of the patients and is usually of modest clinical relevance.1 Subclinical liver involvement is frequent in SLE.2 Review of the literature shows that none of the reported cases of hepatobiliary involvements secondary to lupus were as an initial presentation in the patients, i.e. the patients had suffered other complications of lupus before and experienced a past medical history of SLE treatment. We statement a case of liver involvement due to lupus in a previously healthy woman complaining of severe persistent vomiting admitted in our hospital. It seems that it is the first statement of such liver involvement as a main presentation of SLE in the literature. CASE PRESENTATION A 29-year-old non-pregnant female was admitted in our hospital suffering from fever, abdominal pain and vomiting. She was frequented three times by her physician because of recurrent vaginitis. She reported history of menstrual irregularities and painful intermittent arthritis in her knees and wrists since three months ago. The swelling improved in a few days. Her mother and aunt CC-401 experienced a history of abortions. In addition, eighteen days before admission, she and her husband had a history of diarrhea and fever with severe vomiting after a trip suggesting traveler’s diarrhea. The problem was treated by conservative therapy. Two days later, her body temperature rose to 38 C and she suffered vomiting and moderate epigastric pain. After one week, she sought clinical attention with a complaint of severs fever, vomiting and icterus. At this time, trifluoperazine, metronidazole and famotidine were prescribed. She was also advised to check HBsAg but she refused. Two days later (on the third day of menstruation), with no improvements observed, she referred to another medical center. She complained of abdominal pain, severe dehydration, insomnia, loss of appetite and high grade fever. Urinary analysis showed moderate pyuria (WBC count up to 5 per high power field) and a leukocytosis (WBC = 16000 /mm3; normal range = 4000-11000 /mm3). Abdominopelvic sonography revealed no abnormalities. She was injected two doses of ceftriaxone and was then discharged. Three days later, she went to another hospital again. In new laboratory tests, there were moderate leukocytosis and normal hemoglobin and platelets, (WBC = 13000 /mm3, Hb = 12.3 g/dL, Plt = 175000 /mm3). Bilirubin level was in the normal range, whereas the hepatic enzymes and erythrocyte sedimentation rate were mildly elevated [SGOT (AST) = 79 IU/L (normal range: up to 40); SGPT (ALT) = 59 IU/L (normal range: up to 35); ESR = 127 mm/hr (normal rang: up to 30)]. With the suspicion of drug induced hepatitis, all previous drugs were discontinued. Three days later, she was admitted in our center with high grade fever and severe persistent vomiting. She was febrile and experienced dry oral mucosa and generalized abdominal tenderness, mostly on the right upper quadrant. Her pulse and respiratory rates CC-401 were 120 and 42 per minute, respectively. Her oral body temperature was 39.5 C. Her blood pressure was 120/80 mmHg. Joint examination was unrevealing. The results of laboratory assessments around the 5th day after admission are offered in Table 1. Table 1 Rheumatologic and routine laboratory tests around the 5th day after admission Open in a separate windows In abdominal sonography, a little amount of free fluid was reported in the periphery of spleen, gallbladder, right side of bladder, anterior part of right kidney, and slightly in the interloop space. The thickness of the gallbladder wall Rabbit Polyclonal to CPB2 was also increased. Ceftriaxone was administrated for the patient. The next morning, she was slightly better (body temperature = 37.2 C), but in the evening, the heat increased again (T = 39 C). Therefore, imipenem and vancomycin were started. In repeated.