• acute gastrointestinal injury
• acute intestinal pseudo-obstruction
• invasive candidiasis
• lupus enteritis
• systemic lupus erythematosus

• Case report
• Computer tomography
• Gastrointestinal involvement
• Lupus enteritis
• Lupus mesenteric vasculitis
• Systemic lupus erythematosus
• Ultrasonography

• Abdominal computed tomography
• Abdominal pain
• Comb sign
• High-dose glucocorticoids
• Immunosuppressant
• Lupus enteritis
• Mesenteric vasculitis
• Systemic lupus erythematosus
• Target sign

Lupus enteritis is uncommon in patients with SLE and usually presents with anorexia, vomiting, and abdominal pain. Intestinal perforation as an initial manifestation of SLE is rare and can have a grave prognosis if not timely diagnosed.

We report an unusual case of a 22-year-old regularly menstruating female who presented with features of perforation peritonitis as an initial manifestation of lupus enteritis. Intraoperatively, a gangrenous ileal segment with multiple perforations was present. Thus, with an intraoperative diagnosis of perforation peritonitis, a gangrenous segment of the small bowel was resected and a double-barrel jejuno-ileostomy was created.

Lupus enteritis manifesting initially as bowel perforation can be an uncommon cause of acute abdomen. A plain chest X-ray can show gas under the diaphragm suggesting bowel perforation. A contrast-enhanced CT scan of the abdomen is the gold standard in diagnosing lupus enteritis with a good prognosis on steroids.

Primary closure, resection, and anastomosis of small gut or diverting stoma are required for management of perforation. A high degree of clinical suspicion is required for early diagnosis thus preventing the grave prognosis of such an entity.

•

Bowel perforation in patients with SLE is rare.

• Gangrene
• Intestinal perforation
• Lupus enteritis
• SLE

• connective tissue disease
• endoscopy
• malabsorption
• small intestine
• systemic lupus erythematosus

• Abdominal Pain
• Adult
• Ascites
• Diarrhea
• Enteritis/diagnosis
• Enteritis/drug therapy
• Female
• Humans
• Lupus Erythematosus, Systemic/complications
• Lupus Erythematosus, Systemic/diagnosis
• Lupus Erythematosus, Systemic/drug therapy

Lupus is a common autoimmune disorder with the potential to affect all organ systems. Lupus enteritis is a rare complication that is seen in a subset of patients that present with gastrointestinal symptoms. Its diagnosis commonly involves imaging, showing bowel wall edema as the target sign and vascular engorgement of bowel vessels as the comb sign on CT scans. These findings can help guide the diagnosis, but they are nonspecific and are also found in other conditions that cause bowel wall ischemia. These symptoms are reversible if treated with immunosuppressants. Unfortunately, recurrence is common in lupus enteritis and perforation needs to be ruled out on presentation. In this report, we present the case of a patient with known lupus who was diagnosed with lupus enteritis on imaging and was treated with immunosuppressants. The patient's symptoms resolved subsequently. Our case highlights the fact that the appropriate diagnosis and management of this condition require physical exams, labs, and imaging.

• comb sign
• enteritis
• lupus
• target sign

Lupus enteritis is a rare manifestation of systemic lupus erythematosus (SLE). Diagnosis of this condition is difficult, especially in the absence of other symptoms related to active SLE. We present the case of a 25-year-old female with lupus enteritis as the sole initial manifestation of active SLE.

A 25-year-old African American female presented to the Emergency Department complaining of diffuse abdominal pain, diarrhea, nausea, and vomiting for 2 days. Her past medical history was significant for seasonal allergies and family history was pertinent for discoid lupus in her father and SLE in a cousin. The patient’s vital signs on presentation were normal. Her physical exam was remarkable for significant lower abdominal tenderness without guarding or rigidity. A computed tomography of the abdomen and pelvis revealed marked circumferential wall thickening and edema of the proximal and mid small bowel predominantly involving the submucosa. Our main differential diagnoses were intestinal angioedema and mesenteric vein thrombosis. However, mesenteric vessels were patent, and laboratory testing for hereditary angioedema showed a normal C1 Esterase Inhibitor level and low C3 and C4 levels. Infectious work-up was negative. Autoimmune tests showed elevated anti-nuclear antibodies (ANA) (13.6), anti-Smith antibody, and anti-ribonucleoprotein (anti-RNP) antibody. The patient was diagnosed with SLE enteritis. She was maintained on bowel rest, given intravenous hydration, and started on methylprednisolone 60 mg IV daily. She had significant improvement in her abdominal pain, diarrhea, and emesis after 2 days of treatment. Steroids were tapered and maintained on Hydroxychloroquine with no relapses one year after presentation.

This case of lupus enteritis represents a rare manifestation of SLE. Diagnosis requires clinical suspicion, characteristic imaging and laboratory tests. Endoscopic appearance and biopsies usually yield non-specific findings. High dose steroids are the preferred treatment modality for moderate and severe cases.

• Lupus enteritis
• Systemic lupus erythematous
• Abdominal pain
• Hereditary angioedema
• Case report

• Biomarkers
• LC-ESI-MS/MS
• Lupus: 2D-gel electrophoresis
• Plasma proteins
• Proteomic analysis
• Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disorder which can affect multiple organs and clinical presentation is often a myriad of symptoms; therefore, the index of suspicion should rise when evaluating patients with multiorgan symptomatology. Lupus enteritis is a distinct subset of SLE, defined as either vasculitis or inflammation of the small bowel, with supportive image and/or biopsy findings. The clinical picture of lupus enteritis is often nonspecific, with mild to severe abdominal pain, diarrhea, and vomiting being the cardinal manifestations. Although considered a form of visceral or serosal vasculitis, lupus enteritis is seldom confirmed on histology, making computerized tomography (CT) the gold standard for diagnosis. Lupus enteritis is generally steroid-responsive, and the route of administration is based on clinical status and organ involvement, with preference for intravenous (IV) route in flares with significant tissue edema. The following case describes a young woman presenting with lupus enteritis and lupus panniculitis as an initial manifestation of SLE, the utilization of abdominal CT in diagnosis, and current treatment protocols used for lupus enteritis.