Fatal evolution of systemic lupus erythematosus associated with Crohn's disease

Abstract

The authors describe the case of a young Brazilian woman who was treated of ileocolonic Crohn's disease sparing rectum, as confirmed by colonoscopy and histopathological examination. After a 4-year course of sulfasalazine treatment, she presented with skin facial lesions in vespertilio, fever, arthralgias and high titers of anti-ANA and LE cells. A sulfasalazine-induced lupus syndrome was diagnosed, because after sulfasalazine withdrawal and a short course of prednisone, the clinical symptoms disappeared and the laboratory tests returned to normal. Mesalazine 3 g/day was started and the patient remained well for the next 3 years, when she was again admitted with fever, weakness, arthralgias, diplopy, strabismus and hypoaesthesia in both hands and feet, microhematuria, haematic casts, hypocomplementemia and high titers of autoimmune antibodies. A diagnosis of associated systemic lupus erythematosus was made. Although a pulsotherapy with methylprednisolone was started, no improvement was noticed. A cyclophosphamide trial was tried and again no positive results occurred. The patient evolved to severe clinical manifestations of general vasculitis affecting the central and peripheral nervous system and lungs, having a fatal evolution after 2 weeks. Although uncommon, the association of both disease may occur, and the authors call attention to this possibility, making a brief review of literature.

Autoimmune gastrointestinal complications in patients with systemic lupus erythematosus: case series and literature review

“…3 The association of SLE and UC is very uncommon and only documented in a limited number of case reports. [26][27][28][29][30] The estimated prevalence of UC in SLE patients is around 0.4%. 1,3,11,25,31 Concomitant ChD has been reported even less frequently.…”

“…25,27 Similarly, in patients with IBD and various extra-intestinal manifestations, the coexistence of SLE should be considered. 26,29 The use of anti-TNF alpha inhibitors in IBD patients seems to have a role in the formation of ANA and/or anti-dsDNA antibodies. However, these antibodies are not generally associated with clinical symptoms and signs of autoimmunity, and the role that TNF alpha has in SLE is controversial.…”

Diarréia como manifestação inicial de lúpus eritematoso sistêmico

“…O prognóstico é melhor quando há associação, do que no lúpus isoladamente (9) . Entretanto, no Brasil foi relatado um caso de evolução fatal, em que a doença de Crohn foi diagnosticada primeiro (10) . No Brasil, onde a tuberculose é infecção freqüente, o acometimento intestinal pode ocorrer de maneira isolada ou associada a manifestações sistêmicas, como febre, linfonodomegalia e comprometimento pulmonar.…”

Manifestações extra-intestinais em doença de Crohn e retocolite ulcerativa: prevalência e correlação com o diagnóstico, extensão, atividade, tempo de evolução da doença

“…As doenças inflamatórias intestinais têm chamado a atenção da comunidade científica pela multiplicidade de manifestações no trato digestivo e pela sua incidência em ascensão 8,17,28,37,42,48,97,98 . Em nosso meio, pode-se concluir que o mesmo esteja ocorrendo face ao crescente número de publicações 4,5,6,7,19,30,34,50,58,62,63,64,73,76,81,82,85,90,94,96,98,103,104,105,106,107,108,109,110,111,112,113,114,115,116 . Sabe-se que estas doenças inflamatórias intestinais não se limitam apenas a manifestações no aparelho digestivo, podendo causar sintomas em vários outros órgãos 1,2,3,12,…”

“…Em nosso meio, pode-se concluir que o mesmo esteja ocorrendo face ao crescente número de publicações 4,5,6,7,19,30,34,50,58,62,63,64,73,76,81,82,85,90,94,96,98,103,104,105,106,107,108,109,110,111,112,113,114,115,116 . Sabe-se que estas doenças inflamatórias intestinais não se limitam apenas a manifestações no aparelho digestivo, podendo causar sintomas em vários outros órgãos 1,2,3,12,13,15,16,17,21,23,25,26,29,30,32,…”