Massive gastrointestinal hemorrhage in systemic lupus erythematosus: successful treatment with corticosteroid pulse therapy.
Although mesenteric vasculitis due to systemic lupus erythematosus (SLE) is relatively uncommon, it is the most dangerous manifestation associated with high mortality. We describe the case of a SLE patient with life-threatening gastrointestinal hemorrhage due to mesenteric vasculitis in whom methylprednisolone pulse therapy was quite effective in controlling the hemorrhage and resulted in a satisfactory long term outcome. A 47-yr-old woman presenting with high fever, rash, and melena was diagnosed with SLE from positive antinuclear antibodies, anti-dsDNA, and low complement titers. Although fever and rash subsided with administration of prednisolone, massive hematemesis appeared with melena. Endoscopy demonstrated bleeding ulceration of the antrum, which was intractable despite intensive antiulcer therapy and transfusion. Surgical exploration revealed ileal penetration, and multiple bleeding ulcerations were observed over the resected ileum as well as the antral ulceration. However, bleeding persisted after surgery and surgical findings prompted us to select methylprednisolone pulse. Hemorrhage responded promptly to the therapy, and the patient has remained well since then for >10 yr. Our report indicates that corticosteroid pulse may serve as one of the therapeutic options for SLE with massive hemorrhage due to widespread mesenteric vasculitis.
Hiraishi
H
H
Department of Gastroenterology, Dokkyo University School of Medicine, Tochigi, Japan.
Konishi
T
T
Ota
S
S
Shimada
T
T
Terano
A
A
Sugimoto
T
T
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D005773:Gastroscopy; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006396:Hematemesis / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008551:Melena / Q000188:drug therapy / Q000209:etiology; D008638:Mesenteric Arteries; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D013276:Stomach Ulcer / Q000209:etiology; D016896:Treatment Outcome; D014456:Ulcer / Q000209:etiology; D014657:Vasculitis / Q000209:etiology
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D008775:Methylprednisolone