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

Affiliations
  • 1Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea. chanheell@paran.com
  • 2Department of Radiology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
  • 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

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.


Cited by  1 articles

Panenteritis as an Initial Presentation of Systemic Lupus Erythematosus
Han Ah Lee, Hye Gi Shim, Young Ho Seo, Sung Jae Choi, Beom Jae Lee, Young Ho Lee, Jong Dae Ji, Jae-Hoon Kim, Gwan Gyu Song
Korean J Gastroenterol. 2016;67(2):107-111.    doi: 10.4166/kjg.2016.67.2.107.


Reference

1). Daniel J Msn Wallace., Hahn Bevra H. Dubois'Lupus Erythematosus. 7th ed.p. 829–47. Philadelphia, Lippincott Williams & Wilkins;2006.
2). Lian TY., Edwards CJ., Chan SP., Chng HH. Reversible acute gastrointestinal syndrome associated with active systemic lupus erythematous in patients admitted to hospital. Lupus. 2003. 12:612–6.
3). Hoffman BL., Katz WA. The gastrointestinal manifestations of systemic lupus erythematous: a review of the literature. Semin Arthritis Rheum. 1980. 9:237–47.
4). Munyard P., Jaswon M. Systemic lupus erythematous presenting as intestinal pseudo-obstruction. J R Soc Med. 1997. 90:48–9.
5). 안중경: 고재현: 전창홍: 차훈석: 김영호: 고은미. 전신성홍반성루푸스환자에서의위장관가성폐색증1예. 대한류마티스학회지. 2002. 9:313–8.
6). 최윤석: 김영옥: 조재형: 김정선: 현영근: 서정필등. 루푸스환자에서급성신우신염에의해합병된급성신부전과허혈성장질환. 대한신장학회지. 2000. 19:740–4.
7). 박지현: 류완희: 박태선: 백홍선. Rhupus syndrome 환자에서발생한lupus enteritis 1예. 대한류마티스학회지. 1999. 6:172–7.
8). 오재천, 조은구, 이용주, 배재익, 김용수, 임현철등. 전신성홍반성루푸스: 복부방사선학적소견. 대한방사선의학회지. 1999. 40:1173–9.
9). Ko SF., Lee TY., Cheng TT., Ng SH., Lai HM., Cheng YF, et al. CT findings at lupus mesenteric vasculitis. Acta Radiol. 1997. 38:115–20.
Article
10). Ho MS., Teh LB., Goh HS. Ischemic colitis in systemic lupus erythematosus-report of a case and review of the literature. Ann Acad Med Singapore. 1987. 16:501–3.
11). Reissman P., Weiss EG., Teoh TA., Lucas FV., Wexner SD. Gangrenous ischemic colitis of the rectum: a rare complication of systemic lupus erythematosus. Am J Gastroenterology. 1994. 89:2234–6.
Full Text Links
  • JKRA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr