Radiographic Findings of Lupus Related Entero-colitis

Abstract

A 28-year-old Caucasian woman presented to the hospital with chest pain, dyspnea and fevers (37.9 °C). She was found to have pericarditis with exudative bilateral pleural effusions. She had experienced 1-week of generalized abdominal pain and watery non-bloody diarrhea. Stool studies were negative for infectious etiology. Rheumatologic investigation showed C-reactive protein 16.54 mg/dL, C3 61.1 mg/ dL, ANA titer > 1:5120, DNA antibody 1:640, and positive lupus anticoagulant. She was diagnosed with systemic lupus erythematosus (SLE) using the American College of Rheumatology (ACR) criteria. CT of the abdomen (portal venous phase) revealed mural edema of the ileum in a striking "target sign" pattern (Fig. 1A), enhancement of the cecum (Fig. 1B), and sigmoid colon. There was mild ascites but no mesenteric vessel abnormality. Colonoscopy visualized mucosal inflammation and ulcers in the cecum, ascending and sigmoid colon, with biopsies showing acute inflammation (neutrophilic infiltration). The clinical presentation and evaluation were consistent with lupus-associated enterocolitis. She was treated with methylprednisolone 60 mg IV daily and hydroxychloroquine 200 mg orally twice daily, with improvement in symptoms. She was discharged on an oral prednisone taper.

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

“…24 Moreover, similar to the predilection sites for CD ulcers, some studies have also documented lesions of lupus enteritis in ileum (85% of cases) and jejunum (80% of cases) as well. 38 In addition to the classic finding of the cobblestone appearance in concurrent CD and SLE, the findings documented in other similar case reports were multiple ulcers in terminal ileum, pseudopolyps, deep pleomorphic ulcers in the colon with skip lesions. 20,37,39 The endoscopic findings of this patient were initially a hyperemic terminal ileum, which progressed into multiple ulcers with surrounding hyperemic areas in the descending colon two years after.…”

Intestinal Submucosal Mucinosis in a Patient With Systemic Lupus Erythematosus: A Case Report

“…10,11 Some patients receive endoscopic biopsy for intestinal lesions, and vasculitis is proven by microscopic findings. 12 However, many other cases show a nonspecific biopsy result, such as acute inflammation and edematous change, 13,14 because the affected vessels are usually located in the deeper unsampled areas.…”