Korean J Gastroenterol.  2016 Feb;67(2):107-111. 10.4166/kjg.2016.67.2.107.

Panenteritis as an Initial Presentation of Systemic Lupus Erythematosus

• Lee HA
• Shim HG
• Seo YH
• Choi SJ
• Lee BJ
• Lee YH
• Ji JD
• Kim JH
• Song GG

• KMID: 2383550
• DOI: http://doi.org/10.4166/kjg.2016.67.2.107

Abstract

Lupus enteritis is a rare, severe complication of systemic lupus erythematosus (SLE), needing prompt diagnosis and proper management. However, SLE rarely presents as lupus enteritis at the time of initial diagnosis. Thus, delayed diagnosis and misdiagnosis are common. We report a case of a 25-year-old woman with lupus panenteritis. The patient had multiple hospitalizations for abdominal pain, nausea, and diarrhea, initially without any other symptoms suggestive of SLE, but was later observed to have malar rash and oral ulcers. Laboratory investigations were compatible with SLE, including positive antinuclear antibody (1:320) with speckled pattern. CT revealed diffuse hypodense submucosal thickening of the stomach, the entire small bowel, colon, appendix, and rectum. Treatment with high-dose corticosteroids followed by maintenance therapy with mycophenolate mofetil, hydroxychloroquine, and azathioprine resulted in clinical improvement. Diagnosis of lupus enteritis requires a high index of suspicion given the low incidence and nonspecific clinical findings.

Keyword

Systemic lupus erythematosus; Enteritis

MeSH Terms

Abdominal Pain/complications
Adrenal Cortex Hormones/therapeutic use
Adult
Brain/diagnostic imaging
Diagnosis, Differential
Diarrhea/complications
Endoscopy, Gastrointestinal
Enteritis/pathology
Female
Humans
Lupus Erythematosus, Systemic/complications/*diagnosis/drug therapy
Magnetic Resonance Imaging
Nausea/complications
Tomography, X-Ray Computed
Adrenal Cortex Hormones

Figure

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  Fig. 1. CT of the patient shows moderate amount of ascites and diffuse hypodense submucosal thickening involving the stomach lower body (A), entire small bowel (B), colon (C), appendix and rectum (D). Sub-mucosal wall thickening of stomach lower body (A, arrow). Focal enhancement of right ureter (C, arrow), suspicious systemic lupus erythematosus involvement.

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  Fig. 2. Upper endoscopy revealed diffuse edematous mucosal change with hyperemia in the entire stomach.

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  Fig. 3. Sigmoidoscopy showed diffuse edematous and scattered erosions at the sigmoid colon.

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  Fig. 4. The brain MRI showed high signal intensity in temporal, parietal, and occipital area. B value, diffusion gradient strength; ADC, apparent diffusion coefficient; FLAIR, fluid attenuated inversion recovery.

Reference

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