Lupus enteritis: A 10-year experience in a single Latin American center

Abstract

Objective The objective is to compare the clinical and laboratory characteristics of systemic lupus erythematosus (SLE) patients with and without lupus enteritis (LE) and to identify the factors associated with the occurrence of LE. Methods We performed a retrospective, case-control study in hospitalized patients with SLE who were admitted to our tertiary hospital between January 2012 and December 2021. Sixteen LE patients (cases) were matched (1:3 ratio) for sex and birth year with 48 non-LE patients (controls). Univariable and multivariable logistic regression analyses were used to identify the variables associated with LE. Results Of 2,479 SLE patients who were admitted to our hospital as inpatients, 16 (0.65%) were diagnosed as having LE. All patients, cases and controls, were of Mestizo ethnicity. SLE was diagnosed simultaneously with the first episode of LE in 10 (62.5%) patients. The median time from SLE diagnosis to the first episode of LE was 7 (IQR 0–78) months. LE patients had a shorter median disease duration [7 (0–78) vs 34 (9.5–79) months], and a significantly longer hospital stay (28.3 ± 15.8 vs 6.5 ± 7.9 days, p < 0.001) than non-LE patients. Most LE patients (93.8%) had concomitant lupus nephritis. LE patients had higher SLEDAI-2K scores than those without LE (20.5 ± 9.4 vs 9.8 ± 10.4, p < 0.001). By multivariable analysis, a higher SLEDAI-2K score (OR 1.10, 95% CI 1.02–1.18; p = 0.015) was independently associated with LE occurrence after adjusting for cutaneous involvement, lymphocyte count, serum creatinine, and serum complement C4. Recurrence was observed in two patients (12.5%), both with a bowel wall thickening > 8 mm. The two patients with large intestine-dominant LE developed intestinal pseudo-obstruction. No patient had life-threatening complications (intestinal hemorrhage, infarction, or perforation), and there were no deaths induced directly by LE itself. Conclusion In patients of Mestizo ethnicity, LE occurs during the early course of SLE, frequently is one of the presenting manifestations of SLE, and in most cases, it presents with concomitant lupus nephritis. Higher levels of disease activity at diagnosis were independently associated with LE occurrence and when recurrences occur, they do so in the context of severe wall thickness.

Rare case of lupus enteritis presenting as colorectum involvement: A case report and review of literature

“…However, the advantage of colon and rectum with or without small intestinal involved) was usually seen in elderly people, as well as in the vesicoureter and conduit involved. This case is the type of large intestine-dominant with extra-intestinal symptoms, such as hydroureter, but the patient of our case also had biopsy-proven lupus nephritis, which is often seen in the small intestine-dominant type[ 10 , 11 , 18 ]. However, in our case, only the colon and rectum were involved, while the small intestine was uninvolved.…”

“…Due to the risk of eating tetter and treatment with large dose immune suppression treatment. LE patients have a higher rate (31.3%) of infectivity, as reported by the latest reported studies, which is one of the reasons for the majority of LE deaths[ 10 ]. The diagnose is difficult when it is only through the results of clinic and laboratorial, while CT manifestations are quite typical, so we should combine the CT images to improve the diagnosis accuracy.…”

“…Arteritis and venulitis of the colon and rectum may be the result of aggravation of SLE. Vasculitis is the most common cause of mucosal damage[ 22 ].The deposition of immune complexes in the vascular endothelium, arterial muscular and elastic elements by circulation autoantibodies may lead to leukocytoclastic vasculitis[ 10 , 24 , 28 ], thrombosis and vasculitis of vessels supplying of the intestine vessels walls and the target organ[ 8 , 29 ]. The involvement of the renal and intestinal small vessels may be the major cause due to the autoimmune disorder and active SLE, especially when other causes have been excluded[ 30 ].…”

“…The literature reported that patients with bowel wall thickness ≥ 8-9 mm may experience recurrence, which is up to 23% of the LE cases. Koo et al [ 33 ] have identified colon and urinary tract involvement (especially lupus cystitis) was also the main risks factors of recurrence[ 5 , 10 , 33 , 34 ], because of lupus cystitis and LE, and there was a strong correlation in the pathogenesis[ 35 ]. According to the basic manifestations and danger elements, the patient was reposeful because of the significant improvement with drug treatment, and there were no confirmed recurrences during follow-up from November 2020 to May 2023.…”

“…However, at the most recent telephone follow-up, the patient presented for abdominal pain again in June 2023, considering the possibility of LE recurrence, the specific treatment was uncertain. Her recurrence was most likely associated with severe thickness of the bowel wall (> 8-9 mm), lupus nephritis and intestinal pseudo-obstruction in those with the large intestine-dominant type[ 10 , 11 ].…”