title: Rectal ulcers induced by systemic lupus erythematosus.
abstract: A 28-year-old woman presented with diarrhoea, haematochezia, tenesmus and rectal pain for 2 months. She was diagnosed with systemic lupus erythematosus (SLE) 8 years ago and remained on prednisone, azathioprine and hydroxychloroquine. Blood work revealed a positive ANA (antinuclear antibody test), anti-dsDNA 749 IU/mL (0-300 IU/mL), C3 0.22 g/L (0.65-1.65 g/L) and C4 0.05 g/L (0.16-0.60 g/L). Stool studies were unremarkable. MRI of the pelvis showed a rectum with eccentric wall thickening. Flexible sigmoidoscopy showed severe proctitis with multiple deep ulcers and diffuse submucosal haemorrhage. Rectal biopsy revealed crypt architectural distortion and reactive fibrosis in the lamina propria. The patient was given mesalamine suppository for 2 weeks with minimal improvement. Repeat flexible sigmoidoscopy showed a coalesced 3×4 cm full-thickness rectal ulcer. Therefore, the patient was given intravenous methylprednisolone for 3 days, followed by intravenous cyclophosphamide for 2 weeks. Her symptoms resolved and repeat flexible sigmoidoscopy showed fibrotic healing of the rectal ulcers.
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alan Hoi Lun
authors.initials: AH
authors.lastname: Yau
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Chu
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Hui Min
authors.initials: HM
authors.lastname: Yang
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Hin Hin
authors.initials: HH
authors.lastname: Ko
mesh_terms: D000328:Adult; D001706:Biopsy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007275:Injections, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000008:administration & dosage; D012002:Rectal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012007:Rectum / Q000473:pathology; D012812:Sigmoidoscopy; D014456:Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D008775:Methylprednisolone