J Korean Rheum Assoc.  2007 Sep;14(3):274-278. 10.4078/jkra.2007.14.3.274.

A Case of Extensive Involvement of Lupus Enteritis, from Small Bowel to Rectum

• Kim DH
• Na HJ
• Choi YR
• Nam DH
• Lee CH
• Park SM
• Kang W

• KMID: 2202178
• DOI: http://doi.org/10.4078/jkra.2007.14.3.274

Abstract

Systemic lupus erythematosus (SLE) is a multisystem ic inflammatory disorder mediated by autoantibodies and immune complexes that manifests with a variety of symptoms. Lupus enteritis is a serious complication of SLE and carries a high mortality rate, however the diagnosis is not easy for there are no specific clinical manifestations and laboratory findings. Lupus enteritis usually involves the mesenteric arteries causing ischemic changes of the small and large bowels, and yet rarely involves the rectum. Here, we report a case of a 26-year-old female lupus enteritis patient who presented with atypical abdominal pain. Early diagnosis was made by abdominal pelvic computed tomography (CT) scan, which showed extensive involvement of lupus enteritis from proximal small bowel to rectum. She recovered after being treated with high dose steroid therapy.

Keyword

Systemic lupus erythematosus; Lupus enteritis; Extensive

MeSH Terms

Abdominal Pain
Adult
Antigen-Antibody Complex
Autoantibodies
Diagnosis
Early Diagnosis
Enteritis*
Female
Humans
Lupus Erythematosus, Systemic
Mesenteric Arteries
Mortality
Rectum*
Antigen-Antibody Complex
Autoantibodies

Figure

• 

  Fig. 1. Simple abdomen supine view shows severe small bowel dilatation and diffuse haziness. This finding suggests small bowel obstruction and ascites.

• 

  Fig. 2. Abdominal pelvic CT on hospital day 3. (A) Abdominal pelvic CT scan shows proximal loop dilatation, ascites, and diffuse submucosal thickening of small bowel with alternating layers of high and low attenuation, so-called “target sign”.(thin arrow; small bowel) Thick arrow represents submucosal wall thickening and enhancement of ascending colon. (B) Abdominal pelvic CT scan shows multiple target signs of small bowel and diffuse submucosal thickening at descending colon.(arrow; descending colon) This finding suggests inflammatory and ischemic changes of the bowels.

• 

  Fig. 3. (A) Enhanced abdominal CT scan shows benign circumferential wall thickening, patch wall enhancement of the sigmoid colon, and mesenteric vascular engorgement, which are compatible with inflammatory and ischemic changes. (B) Enhanced abdominal CT scan shows benign circumferential wall thickening and patch wall enhancement of the rectosigmoid colon.

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