Lupus enteritis as the sole presenting feature of systemic lupus erythematosus: case report and review of the literature

Chowichian, Monthira; Aanpreung, Prapun; Pongpaibul, Ananya; Charuvanij, Sirirat

doi:10.1080/20469047.2018.1504430

Cited by 11 publications

(6 citation statements)

References 13 publications

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“…56% of patients reported in the literature underwent an endoscopic procedure with biopsy; 1 patient had a colonoscopy[5], 2 patients had an upper endoscopy[7,10], 1 patient had both endoscopy and colonoscopy[4], and 1 patient had a small balloon enteroscopy (SBE). Only the small balloon enteroscopy by Chowichian et al[9] yielded a definitive diagnosis of vasculitis, which re-iterates the fact that endoscopy is of low yield in lupus enteritis. In our case, we did not perform endoscopy and were able to establish a diagnosis and management plan quickly.…”

Section: Discussionmentioning

confidence: 96%

“…Nevertheless, it is still imperative to identify and adequately treat this disease manifestation in a timely manner as it can have a mortality of 2.7% [13]. In addition, diagnostic uncertainty can lead to unnecessary invasive and costly procedures, such as appendectomy[6], exploratory laparoscopy[7,12], laparotomy, and SBE[9]. Lupus enteritis is estimated to recur in up to 23% of cases[13], which correlates with a lower cumulative dosage of prednisone and a shorter duration of treatment[21].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 96%

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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“…7 At times, LE may present with recurrent abdominal pain without other features of SLE. 8 Definition and nomenclature of LE itself are controversial. 1 Either vasculitis in the bowel or bowel wall inflammation has been defined as “LE” in presence of supportive imaging and/or histopathology.…”

Section: Discussionmentioning

confidence: 99%

Recurrent lupus enteritis in a child—chase the calm before the storm

Patra

Bhattarai

Banday

et al. 2021

Lupus

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Systemic lupus erythematosus (SLE) is a complex multisystemic autoimmune disease. Lupus enteritis (LE), one of the less commonly described manifestations of childhood SLE, presents with relatively nonspecific clinical and laboratory features. In addition, recurrent episodes of LE occurring in temporal proximity are rare in children. Presence of disease activity at other sites (which may not be seen universally) supports the diagnosis of LE in an appropriate setting. Because of its potential role to cause ischemic complications, early recognition and prompt treatment are necessary for a good outcome. Herein, we describe a child with recurrent LE with an interval of about 3 months between the first and the second episode. The first episode correlated with systemic disease activity and bowel thickening was noted on abdominal ultrasonography. This episode was successfully managed with intravenous methylprednisolone pulse therapy. Conversely, the second episode was not associated with significant clinical and laboratory evidence of disease activity at other sites and the initial abdominal ultrasonography was non-contributory. Diagnostic and therapeutic delays, hence, led to the development of fatal complications. We highlight that a high index of suspicion of LE and a timely aggressive treatment is imperative for optimal outcomes even in rare pediatric cases of recurrent LE that may have normal imaging findings initially and may not be associated with systemic lupus erythematosus disease activity index (SLEDAI).

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“…An abdominal-CT scan showed small bowel thickening and fat stranding in the left lower abdomen while a colonoscopy identified an intestinal vasculitis. A treatment with pred-nisone and hydroxychloroquine was started with a subsequent progressive resolution of GI manifestations [86].…”

Section: Lupus Mesenteric Vasculitismentioning

confidence: 99%

Gastrointestinal Involvement in Children with Systemic Lupus Erythematosus

et al. 2023

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Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder. When it presents before the age of 18 years (childhood-onset systemic lupus erythematosus, cSLE), the disease course tends to be more severe with a higher rate of organ involvement and requires an early diagnosis. Gastrointestinal involvement in cSLE is rare and scarcely reported in the literature. Any organ of the gastrointestinal system may be affected, either as a direct consequence of the disease, as a subsequent complication, or as an adverse drug event. Abdominal pain is the most common GI symptom, it can be diffuse or well localized, and can underline different conditions such as hepatitis, pancreatitis, appendicitis, peritonitis, or enteritis. cSLE may have an alteration of the intestinal barrier with features of protein-losing enteropathy or, in genetically predisposed patients, may develop associated autoimmune disorders such as Coeliac Disease or Autoimmune Hepatitis. The aim of this manuscript is to provide a narrative review of gastrointestinal manifestations in cSLE focused on hepatic, pancreatic, and intestinal involvement. A comprehensive literature search based on the PubMed database was performed.

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Lupus enteritis as the sole presenting feature of systemic lupus erythematosus: case report and review of the literature

Cited by 11 publications

References 13 publications

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

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

Recurrent lupus enteritis in a child—chase the calm before the storm

Gastrointestinal Involvement in Children with Systemic Lupus Erythematosus

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