Huang H, Li P, Zhang D, Zhang MX, Yu K. Acute flare of systemic lupus erythematosus with extensive gastrointestinal involvement: A case report and review of literature. World J Gastrointest Surg 2023; 15(9): 2074-2082 [PMID: 37901723 DOI: 10.4240/wjgs.v15.i9.2074]
Corresponding Author of This Article
Ping Li, PhD, Doctor, Department of Rheumatology and Immunology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110000, Liaoning Province, China. graceli008@sohu.com
Research Domain of This Article
Immunology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2023; 15(9): 2074-2082 Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.2074
Acute flare of systemic lupus erythematosus with extensive gastrointestinal involvement: A case report and review of literature
Hua Huang, Ping Li, Dan Zhang, Ming-Xuan Zhang, Kai Yu
Hua Huang, Ping Li, Ming-Xuan Zhang, Department of Rheumatology and Immunology, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China
Dan Zhang, Department of Nutrition, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China
Kai Yu, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China
Author contributions: Huang H and Li P contributed to manuscript drafting; Zhang MX was the physician responsible for the patient's diagnosis and treatment in the Rheumatology and Immunology Department; Zhang D was the patient’s nutritionist and provided nutritional guidance; Yu K was the patient’s admitting physician in the Gastroenterology Department; All authors were responsible for the revision of the manuscript and final approval for submission.
Informed consent statement: Consent was obtained from the patient, both verbally and in written form and has been attached to this submission.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ping Li, PhD, Doctor, Department of Rheumatology and Immunology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110000, Liaoning Province, China. graceli008@sohu.com
Received: April 24, 2023 Peer-review started: April 24, 2023 First decision: June 12, 2023 Revised: July 9, 2023 Accepted: July 28, 2023 Article in press: July 28, 2023 Published online: September 27, 2023 Processing time: 151 Days and 4.7 Hours
Abstract
BACKGROUND
Lupus mesenteric vasculitis (LMV) is a serious condition that may occur as an acute manifestation of gastrointestinal (GI) involvement and is not easily diagnosed by physicians. Delayed diagnosis and treatment of LMV may lead to rapid disease progression and can be life threatening.
CASE SUMMARY
A previously healthy 27-year-old woman presented with abdominal pain following a history of fatigue and consumption of cold water. Laboratory investigations, physical examinations, and enhanced abdominal computed tomography (CT) suggested systemic lupus erythematosus complicated by LMV. She received treatments, such as GI decompression, somatostatin, glucocorticoids, and immunosuppressants, and was evaluated using color ultrasonography. Twenty days later, the patient reported no stomach discomfort and was able to consume semi-liquid food. Laboratory investigations showed that inflammatory factors decreased to normal levels and complement levels increased slightly. One year after discharged, she recovered with methylprednisolone being tapered to 4 mg per day, mycophenolate mofetil to 0.75 g bid, and hydroxychloroquine to 0.2 g bid; however, only C3 complement level was slightly below the normal level.
CONCLUSION
Early diagnosis of LMV is essential for successful treatment; this depends on a combination of clinical manifestations, laboratory investigations, and imaging findings. Enhanced CT is preferred, but ultrasonography can be used for prompt screening and follow-up.
Core Tip: When a systemic lupus erythematosus patient presenting with gastrointestinal symptoms, lupus mesenteric vasculitis (LMV) must be considered despite being rare. Enhanced abdominal computed tomography revealing thicked jejunal wall (target sign) and engorgement of the mesenteric vessels (comb sign) were suggestive of mesenteric vasculitis and provide evidence for accurately treatment. Abdominal ultrasonography can be a reliable tool used for preliminary screening, therapeutic evaluation and follow-up for LMV.
