Ruptured hemorrhagic corpus luteum as a presenting symptom of systemic lupus erythematous
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CASE BASED REVIEW
Ruptured hemorrhagic corpus luteum as a presenting symptom of systemic lupus erythematous Itamar Feldman 1,2 & Bnaya Alon 1,3 & Gideon Nesher 1,2,4 & Talia Wolak 1,4 & Gabriel S. Breuer 1,2,4 Received: 26 April 2020 / Revised: 18 May 2020 / Accepted: 20 May 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract A young female presented to the emergency room with ruptured hemorrhagic corpus luteum (RHCL). Her workup revealed a new diagnosis of SLE with nephritis and positive lupus anticoagulant (LAC) test without thrombocytopenia. We reviewed the literature and found one similar case of a 23-year-old subject who presented with a RHCL that was found to be the presenting symptom of SLE; unlike the current case, the patient presented with severe anemia (Hg 6.7 g/dl) and thrombocytopenia (10,000/ ml). Possible mechanisms are discussed. Keywords Antiphospholipid antibodies . Corpus luteum . Systemic lupus erythematosus
Introduction Ovarian hemorrhagic corpus luteum cysts are common in women of reproductive age and are usually minor events without clinical significance. A hemorrhage into the corpus luteum is a consequence of the vascularization phase following ovulation. Ruptured hemorrhagic corpus luteum (RHCL) is an ovarian cyst rupture that results if blood is spilled into the peritoneal cavity, usually due to the cystic cavity filling with blood and a high intraluminal pressure. The classical risk factors for ruptured corpus luteal cysts are the likelihood of ovulation and vaginal intercourse [1]. Additional known risk factors are bleeding disorders and anticoagulation treatment [2]. Therefore, it is understandable why patients with thrombocytopenia subsequent to systemic lupus erythematosus (SLE) or those with antiphospholipid antibodies (APLA) who take
* Gabriel S. Breuer [email protected] 1
Department of Internal Medicine, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem, Israel
2
Rheumatology Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem, Israel
3
Nephrology Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem, Israel
4
Hadassah Hebrew University School of Medicine, 9112001 Jerusalem, Israel
anticoagulants have a higher risk of hemorrhagic corpus luteum rupture. This case concerns a young female with SLE and positive lupus anticoagulant (LAC) test without thrombocytopenia who presented with RHPL as the presenting symptom of SLE. We reviewed the literature and found one similar case of a 23-year-old subject who presented with a RHCL that was found to be the presenting symptom of SLE; unlike the current case, the patient presented with severe anemia (Hg 6.7 g/dl) and thrombocytopenia (10,000/ml) [3]. The patient and her parents gave consent to publishing the case.
Case presentation An 18-year-old female presented with sudden RLQ (right lower quadrant) abdominal pain, nausea, and vomiting 8 days after her last menses. Upon emergency room (ER) admission, the vital signs were within normal limits (blood pressure 97/60, pulse 80 BPM, f
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