Lupus enteritis: an uncommon manifestation of systemic lupus erythematosus.
We report the case of a 25-year-old Iraqi woman who had multiple hospitalizations at an outside hospital for abdominal pain, nausea, and diarrhea without any evidence of systemic lupus erythematosus. Laboratory investigations finally showed a positive antinuclear antibody (1280), positive anti-dsDNA, anti-β2 glycoprotein I, low complement, positive Coombs tests, and leukopenia. A kidney biopsy showed ISN class II lupus nephritis. An ileal biopsy and angiogram were unremarkable. A computed tomography showed marked and dramatic bowel edema involving the small and large bowel ("target sign"), dilatation of intestinal segments, engorgement of mesenteric vessels ("comb sign"), and increased attenuation of mesenteric fat. These cardinal signs on computed tomography scan led to the correct diagnosis of lupus enteritis. Treatment was commenced with high-dose corticosteroids followed by mycophenolate mofetil, hydroxychloroquine, and then oral cyclophosphamide, but failed. The patient was eventually treated with the Euro-Lupus intravenous cyclophosphamide regimen, which resulted in significant clinical and radiological resolution.
Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD, USA. Lsmit127@jhmi.edu
Lanaya Williams
LW
Smith
Michelle
M
Petri
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D003113:Colonoscopy; D003520:Cyclophosphamide / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D004751:Enteritis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008181:Lupus Nephritis / Q000175:diagnosis / Q000188:drug therapy; D014057:Tomography, X-Ray Computed
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D001379:Azathioprine