No abstract
Background:The prevalence of lupus enteritis (LE) is 2% one of gastrointestinal manifestation of the involvement of the LES. The rapid onset of these symptoms requires determining the life-threatening conditions, but their detection becomes a challenge. We present a series of 6 cases of LE, the most clinical findings and limitations in our environment.Objectives:Our objective was to describe six cases of lupus enteritis, its diagnostic challenge in our country with limited resources, frequent clinical presentations and its management.Methods:We retrospectively reviewed the medical records of 6 patients in our hospital with a diagnosis of SLE according to SLICC ACR 2010 criteria between 2017-2018 for suspicion of lupus enteritis. we discard infectious etiology.Results: Case Age (years) SLE evolution time SLEDAI Diarrhea Abdominal pain Vomit Sickness Fever 1 2912 years2901110 2 242 years2411101 3 254 years2511000 4 231 years2311000 5 166 months1611110 6 228 months2311010 ANA AntiDNAds C3 C4 CRP mg/dl Leukocytes Hemoglobin (g/dl) Creatinine (mg/dl) Proteinuria Kidney Biopsy CT Findings Treatment Intestinal Biopsy Homogeneous 1: 1280NA601212.38.58.31.450.3 gr/ltNATarget ShootingmPDN + CYCNAHomogeneous 1: 1280NA277.65.915.6121.060.22 gr/ltNATarget ShootingmPDN + CYCNAFine speckled 1:320NA34.5101.67.38160.821 gr/ltNATarget ShootingmPDN + MMFNAHomogeneous 1: 1280NA102.2220.38.112.20.9> 3gr/ltNATarget ShootingmPDN + CYCRectal ampulla biopsy: Chronic non-specific mild colitisHomogeneous 1: 1280140 UI29802.6110.553 gr/ltIIITarget ShootingmPDN + CYC + RTXNAHomogeneous 1: 1280NA3470.58.410.61.74> 3gr/ltIIITarget ShootingmPDN + CYCNAWe describe 6 cases, all the patients were woman with a mean age of 23.1 years and an average of 3.6 years until the presentation of enteritis. The clinical symptoms included mainly abdominal pain (100%), vomiting (50%), diarrhea (83%), nausea (50%) and fever (16%). The laboratory characteristics mainly reflect the high lupus activity: SLEDAI 23 pts. Low levels of complement (83%), anemia (50%). The homogeneous pattern predominated in 83%, antiDNA was quantified only in one patient due to a lack of resources, with high titers. The median level of CRP was 3.3 mg/dL. Only two patients (33%) presented class III lupus nephritis by biopsy. In CT, the sign of target shot was present in all cases. Only 1 patient could be biopsied with non-specific chronic colitis. All patients received corticosteroids as first-line treatment, with additional immunosuppressants with significant improvement. One patient died due to pulmonary complications.Conclusion:We should consider lupus enteritis as a possible initial digestive manifestation in patients with SLE. Its diagnosis requires a high index of suspicion, being the CT one of the fundamental pillars for the diagnosis. There is no consensus in the management, however, it was initiated with pulses of methylprednisolone, with limitations to request immunological studies and biological therapy due to economic implications.Finally, we emphasize the...
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