Lupus Enteritis: An Uncommon Manifestation of Systemic Lupus Erythematosus as an Initial Presentation

Bodh, Vishal; Kalwar, Ritesh; Sharma, Rajesh; Sharma, Brij; Mahajan, S.; Raina, Rajiv; Jarial, Ajay

doi:10.4103/jde.jde_36_16

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…Along with other systems, it can affect the gastrointestinal tract (GIT). [ 1 ] GIT-related symptoms occur in up to 40%–50% of SLE patients and involve any organ along with the GIT. About 75% of patients with GI-SLE have pain abdomen as the most common symptom.…”

Section: Discussionmentioning

confidence: 99%

Lithium Toxicity – A Chameleon to Gastrointestinal Vasculitis as an Initial Presenter of Systemic Lupus Erythematosus

Guru

Behera

Barik

et al. 2023

International Journal of Applied &Amp; Basic Medical Research

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Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease. Gastrointestinal manifesting as nausea, vomiting, and pain abdomen are not so uncommon in SLE flare. However, gastrointestinal intestinal vasculitis as an initial presenter of SLE is very rare. This case report narrated gastrointestinal vasculitis as an initial presentation of systemic lupus erythematous, which mimicked lithium toxicity in a patient of preexisting bipolar disorder who was on long-term lithium therapy. A 26-year-old female presented with abdominal pain and persistent vomiting for 2 months. On further workup, she was antinuclear, anti-Smith, and anti-ds-DNA antibody positive. The serum lithium level was found to be normal computed tomography angiogram of the abdomen suggestive of vasculitis. A final diagnosis of SLE with gastrointestinal vasculitis as an initial presenter was made. She was treated with high-dose corticosteroid, cyclophosphamide, and other supportive care. She improved dramatically and was discharged with an oral corticosteroid, hydroxychloroquine, and ramipril.

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Section: Discussionmentioning

confidence: 99%

Lithium Toxicity – A Chameleon to Gastrointestinal Vasculitis as an Initial Presenter of Systemic Lupus Erythematosus

Guru

Behera

Barik

et al. 2023

International Journal of Applied &Amp; Basic Medical Research

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“…Endoscopy is usually not helpful nor necessary in making the diagnosis of lupus enteritis since only superficial tissue is analyzed[19,20]. The yield of biopsy is only about 6%[17]. Endoscopy with biopsy should be reserved to confirm or rule out alternative etiologies in cases of diagnostic uncertainty[13].…”

Section: Discussionmentioning

confidence: 99%

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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“…Other studies showed prevalence of other GI diagnoses related to SLE, namely intestinal pseudo-obstruction (2%), followed with protein-losing gastroenteropathy (1.9%), and acute pancreatitis (0.7-4%). 8,9 Other rare causes include celiac disease and inflammatory bowel disease (IBD). 8 Lupus enteritis was defined by the British Isles Lupus Assessment Group (BILAG) as vasculitis or inflammation of the small bowel with supportive image and/or biopsy findings.…”

Section: Introductionmentioning

confidence: 99%

“…8 Lupus enteritis was defined by the British Isles Lupus Assessment Group (BILAG) as vasculitis or inflammation of the small bowel with supportive image and/or biopsy findings. 9 The most common presenting symptom of lupus enteritis is abdominal pain (97%), followed by vomiting (42%), diarrhea (32%), and fever (20%). 10 There are no specific markers for lupus enteritis which can aid in diagnosis, but a recent study conducted by Aso et al has shown that anti-ganglionic nicotinic acetylcholine α3 subunit (anti-gAChRα3) could be a potential biomarker for lupus enteritis.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Challenge in Distinguishing Crohn’s Disease from Lupus Enteritis in Systemic Lupus Erythematosus Patient: A Case Report

Layadi

Pribadi

Ariane

et al. 2023

InaJGHE

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Diagnosing Crohn’s disease in systemic lupus erythematosus patients with gastrointestinal symptoms poses a great challenge, due to its rare occurrence and similarity of clinical characteristics between its differential diagnosis. We herein present a rare case of a patient diagnosed with systemic lupus erythematosus, complicated by renal involvement and conspicuous gastrointestinal manifestations. The non-specific gastrointestinal findings in this patient led to challenge in differentiating lupus enteritis from Crohn's disease, as they share many similar aspects in clinical manifestations, endoscopic findings, and histopathological findings. We herein provide the clinical judgement in reaching Crohn's disease in concurrence with systemic lupus erythematosus as the final working diagnosis through scrutinizing and comparing data from similar case studies in the past.

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Lupus Enteritis: An Uncommon Manifestation of Systemic Lupus Erythematosus as an Initial Presentation

Cited by 6 publications

References 8 publications

Lithium Toxicity – A Chameleon to Gastrointestinal Vasculitis as an Initial Presenter of Systemic Lupus Erythematosus

Lithium Toxicity – A Chameleon to Gastrointestinal Vasculitis as an Initial Presenter of Systemic Lupus Erythematosus

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

Diagnostic Challenge in Distinguishing Crohn’s Disease from Lupus Enteritis in Systemic Lupus Erythematosus Patient: A Case Report

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