Obscure Intestinal Bleeding in a Patient With Lupic Nephritis: Diagnosis Doubt and Treatment Impassion

Abstract

BACKGROUNDAmong the autoimmune rheumatic diseases, systemic lupus erythematosus (SLE) stands out for its wide clinical presentation associated with high morbidity and mortality. Renal involvement occurs in about 60% of patients with SLE and, in those who develop end-stage renal disease, angiodysplasia and bleeding from the gastrointestinal tract (GI) can occur in 20-30% of those affected. This study aims to present the case of a patient with lupus nephritis on hemodialysis who presented with GI bleeding whose etiology is difficult to define. CASE REPORTA female patient, 22 years old, was diagnosed in 2020 with SLE, lupus nephritis that progressed to dialysis kidney disease. She presented, in January 2022, with melena and anemia. Thus, she was hospitalized on January 28, 2022 and underwent endoscopy and colonoscopy to investigate the bleeding; however, no justifiable focus was observed. She remained with severe anemia requiring multiple blood transfusions and twice intensive care due to hemoglobin CONCLUSIONThe diagnosis of complications resulting from SLE is challenging even in large centers. In SLE, the causes of GI bleeding do not always result from perforations or blood dyscrasias, and may also be related to angioneogenesis, especially in patients with endstage renal disease, with this good response to the use of thalidomide in series and case reports.