Intestinal pseudo-obstruction associated with biliary tract dilatation in a patient with systemic lupus erythematosus

Kansal, Amit; Jain, Avinash; Thenozhi, S; Agarwal, Vikas

doi:10.1177/0961203312464091

Cited by 20 publications

(13 citation statements)

References 11 publications

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“…5 No specific autoantibodies have been found; however, a few case reports have noted the high prevalence of anti-SSB antibodies in patients with CIPO secondary to SLE. 4,5,9 Our patient had CIPO with haematological involvement as described above, in addition to positive anti-SSB antibodies.…”

Section: Discussionmentioning

confidence: 79%

Chronic intestinal pseudo-obstruction: a rare first manifestation of systemic lupus erythematosus

Khairullah

Raja

Yahya

et al. 2013

Lupus

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Chronic intestinal pseudo-obstruction (CIPO) is a rare clinical syndrome of ineffective intestinal motility characterised by clinical and radiological evidence of intestinal obstruction with no identifiable mechanical lesion. CIPO can either be idiopathic or secondary to a systemic disease, like systemic lupus erythematosus (SLE). Fewer than 30 cases of CIPO secondary to SLE have been reported so far. Here we describe a case of SLE with the initial presentation of CIPO. In SLE-related CIPO, treatment includes a combination of high-dose intravenous corticosteroids, immunosuppressants and supportive care. With awareness of this condition, unnecessary surgical intervention and repeated invasive procedures could be avoided. Early initiation of treatment would avoid complications and bring about resolution of symptoms.

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Section: Discussionmentioning

confidence: 79%

Chronic intestinal pseudo-obstruction: a rare first manifestation of systemic lupus erythematosus

Khairullah

Raja

Yahya

et al. 2013

Lupus

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“…Corticosteroids (methylprednisolone and prednisone) were used as the initial and first-line immunosuppressive therapy in 27 patients (68%), 4 – 9 , 11 , 12 , 14 , 15 , 17 – 21 , 22 – 25 18 of them were given pulses of high dose corticosteroids (500 mg or 1000 mg/day), 5 , 6 , 9 , 11 – 14 , 18 – 21 , 22 , 23 , 25 and 9 patients were discharged on 1 to 2 mg/kg/day methylprednisolone or prednisolone. 4 , 7 , 8 , 15 , 17 , 21 , 24 Twenty-two (81%) of them had a good response to corticosteroids.…”

Section: Resultsmentioning

confidence: 99%

“…Cyclophosphamide was used in 8 cases (20%), 4 , 5 , 11 , 14 , 19 6 of them were used in combination with corticosteroids. 4 , 11 , 14 , 19 Two patients who received only cyclophosphamide had a good response. 5 …”

Section: Resultsmentioning

confidence: 99%

Intestinal Pseudo-Obstruction in Systemic Lupus Erythematosus

Wang

Liu

et al. 2014

Medicine

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Intestinal pseudo-obstruction (IPO) is a rare but dangerous complication of systemic lupus erythematosus (SLE) when the patient has no other manifestations except gastrointestinal symptoms. We performed 1 patient with a 2-month history of recurrent vomiting and abdominal distension. She admitted past surgical histories of cesarean section and appendectomy. A physical examination revealed tenderness in the right lower abdominal on palpation and bowel sounds were weak, 2 to 3 bpm. An x-ray and CT of her abdomen showed intestinal obstruction. The initial diagnosis was adhesive intestinal obstruction. She received surgical treatment because her symptoms had gradually become more frequent and persistent. But she vomited again 2 weeks later after the surgery. Further immunology tests indicated that she had an IPO secondary to SLE. We treated the patient with methylprednisolone pulse for 3 days and followed by prednisone orally. The patient had a good response. Complete remission was achieved on 8 years follow-up.The importance of IPO secondary to SLE lies in an early diagnosis. After the diagnosis is established, immunosuppressive therapy should be the initial and first-line treatment, and surgical intervention is often disappointing and should be carefully avoided. It is necessary to enhance awareness of doctors to IPO secondary to SLE.

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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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Intestinal pseudo-obstruction associated with biliary tract dilatation in a patient with systemic lupus erythematosus

Cited by 20 publications

References 11 publications

Chronic intestinal pseudo-obstruction: a rare first manifestation of systemic lupus erythematosus

Chronic intestinal pseudo-obstruction: a rare first manifestation of systemic lupus erythematosus

Intestinal Pseudo-Obstruction in Systemic Lupus Erythematosus

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

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