Lupus Enteritis as an Initial Presentation of Systemic Lupus Erythematosus

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disorder which can affect multiple organs and clinical presentation is often a myriad of symptoms; therefore, the index of suspicion should rise when evaluating patients with multiorgan symptomatology. Lupus enteritis is a distinct subset of SLE, defined as either vasculitis or inflammation of the small bowel, with supportive image and/or biopsy findings. The clinical picture of lupus enteritis is often nonspecific, with mild to severe abdominal pain, diarrhea, and vomiting being the cardinal manifestations. Although considered a form of visceral or serosal vasculitis, lupus enteritis is seldom confirmed on histology, making computerized tomography (CT) the gold standard for diagnosis. Lupus enteritis is generally steroid-responsive, and the route of administration is based on clinical status and organ involvement, with preference for intravenous (IV) route in flares with significant tissue edema. The following case describes a young woman presenting with lupus enteritis and lupus panniculitis as an initial manifestation of SLE, the utilization of abdominal CT in diagnosis, and current treatment protocols used for lupus enteritis.

Radiographic Findings of Lupus Related Entero-colitis

“…Mesenteric vasculitis is the underlying mechanism. Common sites of involvement are the jejunum (80%) and ileum (85%) [3]. Diagnosis is based on classical CT findings of bowel wall edema > 3 mm (called "target sign"), engorgement of mesenteric vessels (called "coombs sign"), and increased attenuation of mesenteric fat [4].…”

Stercoral Colitis in a Patient with Pediatric Onset Systemic Lupus Erythematosus: Case Analysis and Review of Literature

“…Chronic lupus peritonitis usually presents with gradually developing ascites that is painless. [32] Given the challenge of misleading diagnosis mentioned previously, stercoral colitis can be easily neglected but requires prompt treatment due to the rapidly progressive course of the disease.…”

An Unusual Cause of Abdominal Pain: Lupus Enteritis

“…Even if lupus enteritis has been rarely described as the first presentation of systemic lupus erythematous, it is reported as a challenging diagnosis in such cases. 2,3 The treatment of lupus enteritis relies on complete bowel rest and steroid treatment, usually with complete remission.…”