title: [Gastrointestinal symptomatology as first manifestation of systemic erythematous lupus].
abstract: BACKGROUND
  Systemic lupus erythematodes (SLE) is chronic, often febrile, multisystemic disease unknown origin and relapsing course which affects connective tissue of the skin, joints, kidney and serous membranes. Gastrointestinal manifestations are rarely the first sign of systemic lupus erythematosus.
  
  
  METHODS
  We presented a female patient, 35 years old, whose first symptoms of SLE were paralitic ileus (chronic intestinal pseudo-obstruction) and polyserositis (pleural effusion and ascites). Except for high parameters of inflammation, leucopenia and thrombocytopenia, all immunological and laboratory tests for SLE were negative in the onset of the disease. During next six months the patient had clinical signs of paralitic ileus several times and was twice operated with progressive malabsorptive syndrome. The full picture of SLE was manifested seven months later associated with lupus nephritis. Treatment with cyclophosphamide, corticosteroids and total parenteral nutrition (30 days) induced stable remission of the disease.
  
  
  CONCLUSIONS
  The SLE can be initially manifested with gastroenterological symptoms without any other clinical and immunologic parameters of the disease. If in patients with SLE and gastrointestinal tract involvement malabsorption syndrom is developed, a treatment success depends on both immunosupressive therapy and total parenteral nutrition.
authors.affiliation: Vojnomedicinska akademija, Klinika za nefrologiju, Beograd, Srbija.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Kovacević
authors.forename: Violeta
authors.initials: V
authors.lastname: Rabrenović
authors.forename: Dragan
authors.initials: D
authors.lastname: Jovanović
authors.forename: Marijana
authors.initials: M
authors.lastname: Petrović
authors.forename: Milorad
authors.initials: M
authors.lastname: Rabrenović
authors.forename: Radomir
authors.initials: R
authors.lastname: Matunović