Pediatric Nephrology

, Volume 34, Issue 3, pp 431–433 | Cite as

Abdominal pain, nausea, vomiting, and ascites in a 14-year-old girl with systemic lupus erythematosus: Answers

  • Ahmet Taner Elmas
  • YılmazYilmaz TabelEmail author
  • Ayşe Selimoğlu
  • Şenay Kenç
  • Ramazan Kutlu
Clinical Quiz


Question 1: What are the causes of this pathology?

Ascites is the abnormal accumulation of fluid in the peritoneal cavity and may be caused by many diseases, such as advanced liver disease or cirrhosis, viral hepatitis, pancreatitis, cancers, congestive heart failure, kidney failure, and Budd-Chiari syndrome. Abdominal distention, pain, and respiratory distress are common symptoms of the ascites. Diagnosis is based on physical examination, and radiological imaging. Blood studies including complete blood count, serum albumin and coagulation tests, and radiologic evaluation along with a detailed medical history are needed to reveal possible underlying pathology. Abdominal ultrasonography of our patient showed a thrombus inside the hepatic veins extending to hepatic confluence (Fig.  1) and contrast-enhanced axial computed tomography images showed mottled appearance of the liver, perihepatic ascites, thrombosed hepatic veins, narrowed intrahepatic inferior vena cava, and sparring...


Systemic lupus erythematosus Ascites Venous thrombosis Anti-phospholipid antibody syndrome 


Compliance with ethical standards

Informed consent statement

Informed consent was obtained from the parents of the patient.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Grus T, Lambert L, Grusová G, Banerjee R, Burgetová A (2017) Budd-Chiari syndrome. Prague Med Rep 118:69–80CrossRefGoogle Scholar
  2. 2.
    Espinosa G, Font J, García-Pagan JC, Tàssies D, Reverter JC, Gaig C, Cervantes F, Cervera R, Bosch J, Ingelmo M (2001) Budd-Chiari syndrome secondary to antiphospholipid syndrome: clinical and immunologic characteristics of 43 patients. Medicine (Baltimore) 80:345–354CrossRefGoogle Scholar
  3. 3.
    Afredj N, Guessab N, Nani A, Faraoun SA, OuledCheikh I, Kerbouche R, Hannoun D, Amir ZC, Ait Kaci H, Bentabak K, Plessier A, Valla DC, Cazals-Hatem V, Denninger MH, Boucekkine T, Debzi N (2015) Aetiological factors of Budd-Chiari syndrome in Algeria. World J Hepatol 7:903–909CrossRefGoogle Scholar
  4. 4.
    Love PE, Santoro SA (1990) Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance. Ann Intern Med 112:682–698CrossRefGoogle Scholar
  5. 5.
    Pelletier S, Landi B, Piette JC, Ekert P, Coutellier A, Des-moulins C, Fadlallah JP, Herson S, Valla D (1994) Antiphospholipid syndrome as the second cause of non-tumorous Budd-Chiari syndrome. J Hepatol 21:76–80CrossRefGoogle Scholar
  6. 6.
    Shimizu S, Miyata M, Kamiike W, Ito T, Nakamuro M, Nomura M, Negoro S, Nakamura H, Matsuda H (1993) Budd-Chiari syndrome combined with antiphospholipid syndrome: case report and review of the literature. Vasc Surg 27:501–509CrossRefGoogle Scholar
  7. 7.
    Pandiaraja J, Sathyaseelan A (2016) Budd-Chiari syndrome as an initial manifestation of systemic lupus erythematosus. J Clin Diagn Res 10:OD01–OD02PubMedPubMedCentralGoogle Scholar
  8. 8.
    Ilkgül O, Içöz G, Dayangaç M, Tokat Y, Ozütemiz O (2004) A case of antiphospholipid antibody syndrome with Budd-Chiari and colonic ulcers complicated with gastrointestinal hemorrhage. Turk J Gastroenterol 15:115–116PubMedGoogle Scholar
  9. 9.
    Kuhn A, Bonsmann G, Anders H-J, Herzer P, Tenbrock K, Schneider M (2015) The diagnosis and treatment of systemic lupus erythematosus. Dtsch Ärztebl Int 112:423–432PubMedPubMedCentralGoogle Scholar
  10. 10.
    Duarte C, Couto M, Inês L, Malcata A (2007) Budd-Chiari syndrome and severe thrombocytopenia in a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome. Acta Reumatol Port 32:175–180PubMedGoogle Scholar
  11. 11.
    Rizzati R, Sala S, Tilli M, Marri I, Galeotti R (2003) Budd-Chiari syndrome associated with systemic lupus erythematosus: diagnostic imaging and percutaneous treatment. Radiol Med (Torino) 105:519–523Google Scholar
  12. 12.
    Blum U, Rossle M, Haag K, Ochs A, Blum HE, Hauenstein KH, Astinet F, Langer M (1995) Budd-Chiari syndrome: technical, hemodynamic, and clinical results of treatment with transjugular intrahepatic portosystemic shunt. Radiology 197:805–811CrossRefGoogle Scholar
  13. 13.
    Sciascia S, Mario F, Bertero MT (2010) Chronic Budd-Chiari syndrome, abdominal varices, and caput medusae in 2 patients with antiphospholipid syndrome. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis 16:302Google Scholar
  14. 14.
    DeLeve LD, Valla DC, Garcia-Tsao G, American Association for the Study Liver Diseases (2009) Vascular disorders of the liver. Hepatology 49:1729–1764CrossRefGoogle Scholar
  15. 15.
    Akamatsu N, Sugawara Y, Kokudo N (2015) Budd-Chiari syndrome and liver transplantation. Intractable Rare Dis Res 4:24–32CrossRefGoogle Scholar

Copyright information

© IPNA 2018

Authors and Affiliations

  • Ahmet Taner Elmas
    • 1
  • YılmazYilmaz Tabel
    • 1
    Email author
  • Ayşe Selimoğlu
    • 2
  • Şenay Kenç
    • 2
  • Ramazan Kutlu
    • 3
  1. 1.Department of Pediatric Nephrology, Faculty of MedicineUniversity of İnönüMalatyaTurkey
  2. 2.Department of Pediatric Gastroenterology, Faculty of MedicineUniversity of İnönüMalatyaTurkey
  3. 3.Department of Radiology, Faculty of MedicineUniversity of İnönüMalatyaTurkey

Personalised recommendations