title: Colitis associated with active systemic lupus erythematosus successfully treated with rituximab.
abstract: Intestinal vasculitis is a serious and often underrecognized complication of systemic lupus erythematosus (SLE) usually managed with high-dose corticosteroids. We report a case of corticosteroid refractory colitis (likely due to intestinal vasculitis) that achieved remission with a single cycle of high-dose rituximab. This has not previously been described to our knowledge. A 46-year-old woman with SLE presented with 1-week history of bloody diarrhea, abdominal pain, worsening joint pains, fatigue, and mouth ulcers. There was evidence of increased SLE activity with low C4, raised anti-double-stranded DNA antibody, leukopenia, and anemia. Colonoscopy showed active pancolitis (confirmed histologically). A diagnosis of acute colitis associated with active SLE was made, and she received intravenous methylprednisolone 1 g daily for 3 days followed by 60 mg oral prednisolone daily. She continued to have symptomatic colitis with worsening anemia requiring frequent blood transfusions. She then received 2 doses of rituximab 1 g (750 mg/m(2)) 2 weeks apart that led to improvement in colitis symptoms and SLE disease activity over the next 4 weeks. A repeat colonoscopy (and histology) confirmed good resolution of colitis. Six months later, she continued to be in remission with low-dose prednisolone. Intestinal vasculitis should be considered as a possible cause of acute abdominal pain in SLE as early recognition and treatment can improve long-term survival. Rituximab can be an effective alternative for patients refractory to conventional treatment.
authors.affiliation: Department of Rheumatology, Arrowe Park Hospital, Merseyside, United Kingdom. vipintayal@nhs.net
authors.forename: Vipin
authors.initials: V
authors.lastname: Tayal
authors.forename: Yee Ho
authors.initials: YH
authors.lastname: Chiu
authors.forename: Emmanuel
authors.initials: E
authors.lastname: George
authors.forename: Sunita
authors.initials: S
authors.lastname: Mane
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D003092:Colitis / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D000069283:Rituximab; D016896:Treatment Outcome; D014657:Vasculitis / Q000150:complications / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D000069283:Rituximab; D011239:Prednisolone