Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that can show wide manifestations in many organs. The gastrointestinal tract (GI) is commonly affected in SLE; symptoms are often related to the side effect of medications or to infections. One rare GI complication of SLE is lupus enteritis, a complex of manifestations including intestinal vasculitis and enteric ischemia, which presents with vague symptoms of severe abdominal pain, nausea, vomiting, and diarrhea.
We present the case of a 25-year-old female who was admitted to the hospital with complaints of abdominal pain, vomiting, diarrhea, and a history of SLE. Complicating the patient’s clinical picture and diagnosis was gastrointestinal bleeding requiring multiple blood product transfusions secondary to bleeding Meckel’s diverticulum, lupus flare, and positive stool culture for campylobacter antigen. Repeated upper and lower GI endoscopies with biopsy failed to identify the exact cause of bleeding and GI symptoms; the patient underwent exploratory laparotomy with right hemicolectomy to control bleeding. Microscopic examination revealed marked small vessel acute vasculitis consistent with lupus enteritis, ischemic enteritis, and Meckel’s diverticulum with gastric heterotopia.
Our patient was subsequently aggressively treated; however, she developed further associated complications and died.
The pathologic diagnosis of lupus enteritis is challenging due to the nonspecific clinical symptoms and paucity of pathologic findings on most biopsy specimens. Lupus enteritis must be considered in the differential diagnosis of severe abdominal pain in lupus patients to aid in early diagnosis and treatment as this condition could be severe and potentially fatal.
- Meawad, Hany
- Kobalka, Andrew
- Alastal, Yaseen
- Koltz, Brooke
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