Acute spontaneous hemorrhagic cholecystitis with systemic lupus erythematosus and antiphospholipid antibody syndrome: a case report and literature review.

INTRODUCTION AND

IMPORTANCE

Hemorrhagic cholecystitis (HC) is a rare and serious complication of acute cholecystitis, characterized by intraluminal or extraluminal bleeding within the gallbladder. While commonly associated with gallstones, HC may also arise from coagulopathies, anticoagulant therapy, and autoimmune conditions such as systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). However, HC in patients with SLE or APS is rarely reported in the literature.

CASE PRESENTATION: A 59-year-old female with a history of SLE and APS, on corticosteroids, hydroxychloroquine, methotrexate, and warfarin, presented with acute right upper quadrant pain, vomiting, hematemesis, and melena. Clinical examination revealed right upper quadrant tenderness and positive Murphy's sign. Imaging studies, including ultrasound and computed tomography, confirmed a distended gallbladder with intraluminal hyperdense content and surrounding inflammation. An urgent open cholecystectomy was performed, revealing clotted blood within the gallbladder. The patient recovered uneventfully and was discharged in stable condition.

CLINICAL DISCUSSION: HC is an uncommon but critical condition that requires prompt recognition and intervention. In this case, the coexistence of autoimmune diseases and anticoagulant therapy likely predisposed the patient to HC. Imaging played an essential role in diagnosis, and open cholecystectomy provided definitive management.

CONCLUSION

HC should be considered in patients with SLE, APS, or coagulopathies presenting with acute abdominal symptoms. Early recognition and multidisciplinary management is essential to prevent life-threatening outcomes.