Differential Diagnosis for a 35-year-old Woman with Lupus Presenting with Right Upper Quadrant (RUQ) Pain
Single Most Likely Diagnosis
- Hepatic Involvement due to Lupus: This is a common manifestation of systemic lupus erythematosus (SLE) and can cause RUQ pain due to liver inflammation or vasculitis.
Other Likely Diagnoses
- Gallbladder Disease (Cholecystitis or Cholelithiasis): Patients with SLE are at increased risk for gallbladder disease, which can present with RUQ pain.
- Peptic Ulcer Disease: SLE patients may have an increased risk of peptic ulcers, possibly due to steroid use, which can cause RUQ pain.
- SLE-related Vasculitis: Vasculitis affecting the gastrointestinal tract or liver can cause RUQ pain in patients with SLE.
Do Not Miss Diagnoses
- Hepatic Vein Thrombosis: Although less common, this condition can be life-threatening and requires prompt diagnosis and treatment. SLE patients may be at increased risk due to antiphospholipid syndrome.
- Antiphospholipid Syndrome (APS) related Thrombosis: APS is common in SLE patients and can cause thrombosis in various locations, including the hepatic veins, which would present with RUQ pain.
- Pneumonia: Right upper lobe pneumonia can refer pain to the RUQ and is a potentially life-threatening condition if not promptly treated.
Rare Diagnoses
- Primary Biliary Cholangitis (PBC): An autoimmune disease of the liver that can cause RUQ pain, although it is less common in SLE patients.
- Hepatobiliary Sarcoidosis: A rare condition where sarcoid granulomas affect the liver or bile ducts, causing RUQ pain.
- Amyloidosis: A condition characterized by the deposition of amyloid proteins in various organs, including the liver, which can cause RUQ pain, although it is rare in SLE patients.