title: Acute abdomen in SLE.
abstract: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune connective tissue disease with protean manifestations. Most often it presents with mucocutaneous, musculoskeletal or renal involvement. In comparison, gastrointestinal (GI) manifestations of SLE are far less common. The case presented here highlights the differential diagnosis of GI manifestations of SLE that range from non-life-threatening to serious life-threatening complications, including some of the complications of on-going drug treatments. While some of them present as 'acute abdomen', others are more subacute or chronic, yet serious enough to be life-threatening. The serious GI manifestations of SLE include mesenteric vasculitis causing perforation or hemorrhage with peritonitis, acute pancreatitis and intestinal pseudo-obstruction. The patient in this paper had clinical features, imaging findings and laboratory parameters that helped the treating physician to narrow down the diagnostic possibilities and finally, in making the diagnosis of lupus-pancreatitis. She was treated with intravenous 'bolus' (i.v.-pulse) methylprednisolone for 3 days, i.v.-pulse cyclophosphamide 750 mg (one dose) along with oral methylprednisolone and other supportive measures including blood transfusions. This led to prompt and complete recovery.
authors.affiliation: Department of Rheumatology, ISIC Superspeciality Hospital, Vasant Kunj, New Delhi, India. anand_malaviya@yahoo.com
authors.forename: Anand N
authors.initials: AN
authors.lastname: Malaviya
authors.forename: Amit
authors.initials: A
authors.lastname: Sharma
authors.forename: Divya
authors.initials: D
authors.lastname: Agarwal
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Kapoor
authors.forename: Shriram
authors.initials: S
authors.lastname: Garg
authors.forename: Sadhana
authors.initials: S
authors.lastname: Singh
authors.forename: Roopa
authors.initials: R
authors.lastname: Rawat
mesh_terms: D000006:Abdomen, Acute / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D000284:Administration, Oral; D001803:Blood Transfusion; D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis; D006801:Humans; D007275:Injections, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003520:Cyclophosphamide; D008775:Methylprednisolone