Atypical Presenting Symptoms of Acute Onset Systemic Lupus Erythematosus with Enteritis and Cystitis

Yagita, Mayu; Tsujimoto, Kohei; Yagita, Masato; Fujita, Masaaki

doi:10.1155/2016/8579812

Cited by 11 publications

(13 citation statements)

References 13 publications

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“…Taken the extent of intestinal wall thickening and multi-compartment involvement into considerations, our composite CT image-based scoring system provides a new assessment tool for SLE GI involvement or VPO. The scoring system incorporated both anatomical distribution and intestinal wall thickness, which are known to be relevant to GI dysfunction [18][19][20][21][22][23][24] . We chose the time to PO50 as the parameter to reflect the time to GI function recovery 25 .…”

Section: Discussionmentioning

confidence: 99%

Systemic lupus erythematosus gastrointestinal involvement: a computed tomography-based assessment

Chen

Zhou

et al. 2020

Sci Rep

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Systemic lupus erythematosus (SLe) gastrointestinal (Gi) complication is characterized by multisegment and multi-compartment involvement. The aim of this study is to develop a computed tomography (CT) image-based system for disease evaluation. SLE patients with GI involvement from two independent cohorts were retrospectively included. Baseline abdominal ct scan with intravenous and oral contrast was obtained from each individual. A CT scoring system incorporating the extent of GI tract involvement and intestinal wall thickness, along with extra-GI compartment involvement, was developed and validated. The outcome measurement was the time to GI functional recovery, defined as the time to tolerable per os (po) intake ≥50% of ideal calories (PO50). A total of 54 and 37 patients with SLE GI involvement were enrolled in the derivation and validation cohorts, respectively. The CT scores for SLE GI involvement were positively correlated with patients' time to PO50 (r = 0.57, p < 0.0001, derivation cohort; r = 0.42, p = 0.0093, validation cohort). Patients with a CT score ≤ 3 had a shorter time to PO50 (median time of 0 day) in pooled cohort, whereas those with a CT score > 3 incurred a significantly prolonged recovery with a median time to PO50 of 13 days (p < 0.0001). The CTbased scoring system may facilitate more accurate assessment and individualized management of SLE patients with Gi involvement. Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease with multi-system involvement 1. Gastrointestinal (GI) manifestations are commonly presented in up to 50% of SLE patients 2 , with 2-30% of these cases attributed to active SLE per se 3 ; whereas others may due to treatment side effects or co-morbidities. Several key questions remain undetermined concerning active SLE GI involvement. First, multiplicity of its terminology, such as GI vasculitis (mesenteric vasculitis), lupus gastroenteritis (lupus enteritis) and intestinal pseudo-obstruction (IPO) 4-7 , implies the uncertainty of the underlying pathophysiology. Second, specific assessment tools for its activity, severity and outcome are lacking. As an example, none of the clinical features of SLE GI involvement is captured by the widely used SLE disease activity index (SLEDAI). It is noteworthy that computed tomography (CT) imaging has been well accepted in the evaluation of SLE GI involvement. Certain characteristic radiographic features 8,9 , such as 'target sign' (intestinal wall edema and thickening), 'comb sign' (enhanced engorgement of mesenteric vasculature), extra-GI compartment involvement (gallbladder wall thickening, interstitial cystitis, dilatation of urinary tract and biliary-pancreatic duct), have been described. However, image-based, prognosis-relevant measurable tools are yet to be developed. Third, the current treatment, particularly nutritional protocol for SLE patients with GI involvement, are merely empirical. Although the overall outcome is relatively benign 10 , some patients may suffer from a prolonged GI insufficiency, and some may...

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Section: Discussionmentioning

confidence: 99%

Systemic lupus erythematosus gastrointestinal involvement: a computed tomography-based assessment

Chen

Zhou

et al. 2020

Sci Rep

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“…There is no consensus on the best treatment for lupus cystitis. Steroids such as methylprednisolone and prednisolone, along with other immunosuppressive drugs such as mycophenolate mofetil and cyclophosphamide, have been tried with excellent results 7 8…”

Section: Discussionmentioning

confidence: 99%

Lupus cystitis: unusual cause of renal failure in systemic lupus erythematosus

et al. 2019

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A 42-year-old woman presented with chronic fever, abdominal pain, intermittent loose stools and dysuria for 3 months. She had recently developed acute dyspnoea with acute kidney injury. She was found to have a contracted, thick-walled bladder with bilateral hydroureteronephrosis. She underwent bilateral percutaneous nephrostomies, following which her renal function recovered. She satisfied the clinical and immunological features of the Systemic Lupus International Collaborating Clinics criteria for systemic lupus erythematosus (SLE). She was initiated on immunosuppression. Lupus cystitis with a contracted bladder is an uncommon presentation of SLE.

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“…Dentro de los hallazgos clási-cos se incluyen engrosamiento difuso de la pared intestinal, dilatación de asas intestinales, ensanchamiento e hipervascularización esplácnica, atenuación incrementada de la grasa mesentérica y ascitis [6][7][8] .…”

Section: Discussionunclassified

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

et al. 2017

Rev. méd. Chile

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Atypical Presenting Symptoms of Acute Onset Systemic Lupus Erythematosus with Enteritis and Cystitis

Cited by 11 publications

References 13 publications

Systemic lupus erythematosus gastrointestinal involvement: a computed tomography-based assessment

Systemic lupus erythematosus gastrointestinal involvement: a computed tomography-based assessment

Lupus cystitis: unusual cause of renal failure in systemic lupus erythematosus

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

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