Serositis: Causes, Symptoms, Diagnosis, Treatment and Complications

It refers to the inflammation of the serous tissues of the body, the tissues that line the lungs (pleura), the heart (pericardium) and the inner lining of the abdomen.

It also refers to the internal organs. It is commonly found with fat wrapping.

Another type of serositis related to lupus is pericarditis . Pericarditis is the inflammation of the sac (pericardium) that surrounds the heart. Pericarditis causes fluid to accumulate in the pericardium, making it difficult for the heart to pump blood .

The extra work of the heart causes pain in the chest. If pericarditis is severe, chest pain may increase with normal activity, such as swallowing, coughing or even breathing.

Several names have been applied to this condition:

  • Multiple progressive hyaloserositis.
  • Chronic deforming perihepatitis.
  • Zuckergussleber (liver glaze).
  • Pericarditic pseudocirrhosis of the liver.
  • Multiple serositis
  • Multiple chronic serositis.

Causes of serositis

Like pleuritis, serositis can be symptomatic of other diseases. Doctors should rule out other conditions that lead to serositis, such as:

symptom

The ascites has been the most prominent symptom. Many patients have had their ascitic fluid removed over and over again. It is believed that many patients with suspected cirrhosis of the liver have actually had this form of serositis.

Symptoms related to pain and pleura have been the most common. The disease has been chronic and patients have gradually lost strength, the character of the symptoms depends on the site of maximum inflammation.

Diagnosis of serositis

There are a number of diseases in which serositis is a diagnostic symptom or that commonly occurs. These include Crohn’s disease, lupus, familial Mediterranean fever and juvenile arthritis. All of these are largely inflammatory diseases, and acute serositis or chronic serositis can occur.

Treatment

The treatment of fibrinous serositis depends on the disease that causes the disease. Therefore, diagnosing the original condition will determine the best treatment method.

If a diagnosis of lupus has been made, the treatment of these conditions follows the treatment instructions for other symptoms of lupus. Patients are advised to get plenty of rest and to take non-steroidal anti-inflammatory drugs.

Persistent pain and inflammation may require a cycle of corticosteroids such as prednisone .

Serositis ( pericarditis , pleurisy) responds immediately to nonsteroidal anti-inflammatory drugs and corticosteroids.

Antimalarial agents achieve an improvement in weeks or months. Acute lupus pneumonitis and pulmonary hemorrhage are life-threatening complications and require high doses of corticosteroids with or without cyclophosphamide or apheresis.

Interstitial lung disease is a chronic process that takes years to evolve and is observed more frequently in the overlapping syndromes and associated Sjögren’s syndrome .

It is treated with corticosteroids and immunosuppressants. The evaluation of pulmonary hypertension should be part of the initial evaluation in most patients with lupus.

Present in 2% to 5% of patients with lupus, this serious complication is managed with vasodilator therapy, anticoagulation and endothelial cell activation antagonists, but anti-inflammatory regimens can also reduce pressures.

The pulmonary embolism should be considered in any patient with lupus with acute onset of chest pain and breathlessness and requires anticoagulation therapy.

Outside the pericardium, myocarditis and endocarditis are uncommon manifestations of lupus. The majority of myocarditis is of viral origin (even in patients with lupus), but lupus myocarditis justifies a short test of high doses of corticosteroids.

Myocardial dysfunction and microvascular angina are much more common than previously thought and are treated with beta-blockers and nitrates. Coronary arteritis is very rare and responds to short cycles of high doses of corticosteroids.

Libman-Sacks endocarditis warrants further evaluation to rule out superimposed bacterial endocarditis or an immune complex vegetation that could embolize. Antimicrobial and anticoagulant measures can be instituted.

Complications

Patients with serositis may occasionally have severe abdominal pain and peritonism. Sometimes, abdominal pain is severe and indistinguishable from appendicitis, acute cholecystitis or cholangitis, especially in patients with jaundice , which leads to unnecessary intra-abdominal surgery.

Acute pancreatitis has rarely been reported , although serum amylase may increase in up to 60% of patients with severe disease due to renal failure. Leptospirosis in pregnancy can cause miscarriage, postpartum hemorrhage and intrauterine fetal death.

Congenital leptospirosis rarely occurs. Other rare complications include erythema nodosum, potentially fatal rhabdomyolysis associated with renal failure and reactive arthritis.

These complications appear in variable proportions and can overlap.

Weil’s disease was first described by a German doctor, Professor Adolf Weil, in 1886 in four patients with a febrile illness along with severe nervous symptoms, hepatosplenomegaly, jaundice and signs of kidney disease that recovered quickly.

At present, the term “Weil syndrome” generally refers to the extremely severe form of leptospirosis, characterized by the combination of jaundice, renal dysfunction and hemorrhagic diathesis, especially pulmonary hemorrhage .

This syndrome occurs in less than 10% of patients and has a mortality rate of 5-40%. The overall mortality of patients hospitalized with leptospirosis varies between countries and reports in the series, and usually does not exceed 10%.