An Unusual Cause of Abdominal Pain: Lupus Enteritis

Demiselle, Julien; Sayegh, Johnny; Cousin, Maud; Olivier, Anne; Augusto, Jean-François

doi:10.1016/j.amjmed.2016.01.011

Cited by 8 publications

(10 citation statements)

References 3 publications

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“…In addition to CT manifestations, ultrasonography and magnetic resonance enterography (MRE) can also be used to diagnose LEn. For example, Demiselle et al [ 26 ] described a patient with LEn who had characteristic intestinal wall edema and ascites based on ultrasonography. Cicero et al [ 27 ] used MRE to observe a formation with the appearance of a thumb print caused by bowel ischemia and bowel wall edema in a patient with LEn.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of lupus enteritis: a single-center retrospective study

Chen

Luo

et al. 2021

Orphanet J Rare Dis

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Background Lupus enteritis (LEn) is a rare complication of systemic lupus erythematosus (SLE). Timely diagnosis and treatment of LEn are necessary to prevent the most serious consequences — intestinal perforation, gastrointestinal bleeding, and death. We compared the clinical features of SLE patients with and without LEn. Methods The clinical data of LEn inpatients at Suining Central Hospital from July 2012 to June 2020 were examined. These LEn patients were matched (1:2 ratio) with concurrently hospitalized SLE patients who did not have LEn. The two groups were compared using multivariate logistic regression. Results We compared SLE inpatients with LEn (n = 43) and SLE inpatients without LEn (n = 86) at our institution. Multivariate logistic regression showed that ascites (odds ratio [OR]: 9.961, 95%CI: 2.215–44.802, P = 0.003), hydronephrosis (OR: 28.060, 95%CI: 2.303–341.962, P = 0.009), leukopenia (OR: 5.890, 95%CI: 1.813–19.135, P = 0.003), reduced complement C3 level (OR: 4.791, 95%CI: 1.605–14.300, P = 0.005), and elevated immunoglobin (Ig)A level (OR: 4.040, 95%CI: 1.307–12.487, P = 0.015) were independently associated with LEn. Within the LEn group, abdominal pain was the most common abdominal symptom (88.4%), and increased mesenteric fat attenuation (74.4%) and bowel wall thickening (58.1%) were the most common computed tomography (CT) findings. Most LEn patients (88.4%) required high-dose glucocorticoid therapy (≥ 80 mg methylprednisolone/day), and cyclophosphamide was the most commonly used immunosuppressant (62.8%). Conclusions Abdominal pain was the most common clinical symptom of LEn. Abdominal CT provides important information for detection and diagnosis of LEn. Ascites, hydronephrosis, leukopenia, hypocomplementemia (C3), and increased IgA were independently associated with LEn.

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Section: Discussionmentioning

confidence: 99%

Clinical features of lupus enteritis: a single-center retrospective study

Chen

Luo

et al. 2021

Orphanet J Rare Dis

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“…Computed tomography (CT) scan of the abdomen with contrast is considered the gold standard[3,13]. Lupus enteritis primarily causes submucosal edema of the jejunum and ileum, leading to classic findings of circumferential bowel wall thickening (known as the “target sign”), dilation of intestinal segments, and engorgement of mesenteric vessels (known as the “comb sign”) (Image 1, 2)[19]. The “target sign”, seen on our patient’s CT scan, is not pathognomonic and may be seen in other conditions such as intestinal angioedema, mesenteric vein thrombosis, inflammatory bowel disease, and intestinal infections[13,19].…”

Section: Discussionmentioning

confidence: 99%

“…Lupus enteritis primarily causes submucosal edema of the jejunum and ileum, leading to classic findings of circumferential bowel wall thickening (known as the “target sign”), dilation of intestinal segments, and engorgement of mesenteric vessels (known as the “comb sign”) (Image 1, 2)[19]. The “target sign”, seen on our patient’s CT scan, is not pathognomonic and may be seen in other conditions such as intestinal angioedema, mesenteric vein thrombosis, inflammatory bowel disease, and intestinal infections[13,19]. In similar case reports, 8 of 10 patients received an abdominal CT scan and all mentioned findings of bowel wall edema, thickening, or the “target sign”.…”

Section: Discussionmentioning

confidence: 99%

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Lupus enteritis as the only active manifestation of systemic lupus erythematosus: A case report

Gonzalez

Wadhwa

Salomon

et al. 2019

WJCC

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BACKGROUND Lupus enteritis is a rare manifestation of systemic lupus erythematosus (SLE). Diagnosis of this condition is difficult, especially in the absence of other symptoms related to active SLE. We present the case of a 25-year-old female with lupus enteritis as the sole initial manifestation of active SLE. CASE SUMMARY A 25-year-old African American female presented to the Emergency Department complaining of diffuse abdominal pain, diarrhea, nausea, and vomiting for 2 days. Her past medical history was significant for seasonal allergies and family history was pertinent for discoid lupus in her father and SLE in a cousin. The patient’s vital signs on presentation were normal. Her physical exam was remarkable for significant lower abdominal tenderness without guarding or rigidity. A computed tomography of the abdomen and pelvis revealed marked circumferential wall thickening and edema of the proximal and mid small bowel predominantly involving the submucosa. Our main differential diagnoses were intestinal angioedema and mesenteric vein thrombosis. However, mesenteric vessels were patent, and laboratory testing for hereditary angioedema showed a normal C1 Esterase Inhibitor level and low C3 and C4 levels. Infectious work-up was negative. Autoimmune tests showed elevated anti-nuclear antibodies (ANA) (13.6), anti-Smith antibody, and anti-ribonucleoprotein (anti-RNP) antibody. The patient was diagnosed with SLE enteritis. She was maintained on bowel rest, given intravenous hydration, and started on methylprednisolone 60 mg IV daily. She had significant improvement in her abdominal pain, diarrhea, and emesis after 2 days of treatment. Steroids were tapered and maintained on Hydroxychloroquine with no relapses one year after presentation. CONCLUSION This case of lupus enteritis represents a rare manifestation of SLE. Diagnosis requires clinical suspicion, characteristic imaging and laboratory tests. Endoscopic appearance and biopsies usually yield non-specific findings. High dose steroids are the preferred treatment modality for moderate and severe cases.

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“…Sin embargo, se ha visto que en casos donde la sospecha de enteritis lúpica es alta, la ecografía podría ser una herramienta útil para detectar edema intestinal precoz 9 .…”

Section: Discussionunclassified

Enteritis lúpica como manifestación inicial de lupus eritematoso sistémico. Caso clínico

et al. 2017

Rev. méd. Chile

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An Unusual Cause of Abdominal Pain: Lupus Enteritis

Cited by 8 publications

References 3 publications

Clinical features of lupus enteritis: a single-center retrospective study

Clinical features of lupus enteritis: a single-center retrospective study

Lupus enteritis as the only active manifestation of systemic lupus erythematosus: A case report

Enteritis lúpica como manifestación inicial de lupus eritematoso sistémico. Caso clínico

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