Lupus enteritis is a rare and poorly understood cause of abdominal pain in patients with systemic lupus erythematosus (SLE). In this study, we report a series of 7 new patients with this rare condition who were referred to French tertiary care centers and perform a systematic literature review of SLE cases fulfilling the revised ACR criteria, with evidence for small bowel involvement, excluding those with infectious enteritis. We describe the characteristics of 143 previously published and 7 new cases. Clinical symptoms mostly included abdominal pain (97%), vomiting (42%), diarrhea (32%) and fever (20%). Laboratory features mostly reflected lupus activity: low complement levels (88%), anemia (52%), leukocytopenia or lymphocytopenia (40%) and thrombocytopenia (21%). Median CRP level was 2.0 mg/dL (range 0–8.2 mg/dL). Proteinuria was present in 47% of cases. Imaging studies revealed bowel wall edema (95%), ascites (78%), the characteristic target sign (71%), mesenteric abnormalities (71%) and bowel dilatation (24%). Only 9 patients (6%) had histologically confirmed vasculitis. All patients received corticosteroids as a first-line therapy, with additional immunosuppressants administered either from the initial episode or only in case of relapse (recurrence rate: 25%). Seven percent developed intestinal necrosis or perforation, yielding a mortality rate of 2.7%. Altogether, lupus enteritis is a poorly known cause of abdominal pain in SLE patients, with distinct clinical and therapeutic features. The disease may evolve to intestinal necrosis and perforation if untreated. Adding with this an excellent steroid responsiveness, timely diagnosis becomes primordial for the adequate management of this rare entity.
Following a global morphological and micro-CT scan examination of the original and cast of the skeleton of Australopithecus afarensis AL 288 ('Lucy'), Kappelman et al. have recently proposed a diagnosis of a fall from a significant height (a tree) as a cause of her death. According to topographical data from the discovery site, complete re-examination of a high-quality resin cast of the whole skeleton and forensic experience, we propose that the physical process of a vertical deceleration cannot be the only cause for her observed injuries. Two different factors were involved: rolling and multiple impacts in the context of a mudslide and an animal attack with bite marks, multi-focal fractures and violent movement of the body. It is important to consider a differential diagnosis of the observed fossil lesions because environmental factors should not be excluded in this ancient archaeological context as with any modern forensic anthropological case.
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