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In two patients with systemic lupus erythematosus, an acute lupus crisis developed with multisystem involvement that included peritonitis. Paracentesis was performed and the fluid obtained was sterile and serous. In one patient the antinuclear antibody test performed on the paracentesis fluid showed 4+ peripheral staining. The clinical impression that these episodes represented lupus activity was supported by the results of paracenteses. Laparotomy was not performed and the patients were treated with high doses of intravenous steroids and antibiotics with a favorable response. Frequent abdominal examinations and follow-up gastrointestinal series did not disclose ulceration and/or perforation which may have been masked by the steroids. Paracentesis is recommended as a useful method of distinguishing perforation from peritonitis in patients with systemic lupus erythematosus presenting with an acute abdomen.
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