Intestinal pseudo-obstruction in inactive systemic lupus erythematosus: An unusual finding

Leonardi, Giulia C.; Bortoli, Nicola de; Bellini, Massimo; Mumolo, M.G.; Costa, Francesco; Ricchiuti, Angelo; Bombardieri, Stefano; Marchi, Santino

doi:10.4292/wjgpt.v1.i6.135

Cited by 11 publications

(7 citation statements)

References 6 publications

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“…This result is consistent with previous reports showing that IPO and ureterohydronephrosis can occur with low systemic disease activity even in a stable state of other organ involvement. 22 Moreover, in our study, the SLEDAI scores indicated high disease activity in only 29.5% of the patients, but 50.8% of the patients needed a 3-day pulse of methylprednisolone therapy, suggesting that in SLE patients with IPO and/or ureterohydronephrosis the SLEDAI score is not a reliable reference for evaluating the disease activity and deciding the initial dose of steroids. It has to be emphasized that the SLE patients with IPO and/or ureterohydronephrosis should all be regarded as having active SLE independent of the scoring and given early aggressive treatment.…”

Section: Discussioncontrasting

confidence: 64%

Clinical Analysis of 61 Systemic Lupus Erythematosus Patients With Intestinal Pseudo-Obstruction and/or Ureterohydronephrosis

Liu

et al. 2015

Medicine

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The objective of this article is to investigate the clinical features of intestinal pseudo-obstruction (IPO) and/or ureterohydronephrosis in systemic lupus erythematosus (SLE).Sixty-one SLE patients with IPO and/or ureterohydronephrosis were analyzed retrospectively. A total of 183 cases were randomly selected as controls from 3840 SLE inpatients without IPO and ureterohydronephrosis during the same period. Patients were assigned to 1 of the 3 groups (SLE with IPO and ureterohydronephrosis, SLE with IPO, and SLE with ureterohydronephrosis). The clinical characteristics, treatments, and prognosis were compared between the 3 groups.There were 57 females and 4 males, with a mean age of 32.0 years. IPO was the initial manifestation of SLE in 49.1% of the cases, whereas ureterohydronephrosis in 32.5%. All patients were initially treated with a high-dose steroid. Thirty-one of these patients (50.8%) also received intravenous methylprednisolone pulse therapy. Two patients died of bowel perforation and lupus encephalopathy, and the other 59 patients (96.7%) achieved remission after treatment. The incidences of fever, glomerulonephritis, nervous system involvement, serositis, erythrocyte sedimentation rate elevation, hypoalbuminemia, hypocomplementemia, and anti-SSA antibody positivity were significantly higher in patients with IPO and/or ureterohydronephrosis than in the control group (without IPO and ureterohydronephrosis). Also, patients with IPO and/or ureterohydronephrosis had higher SLE Disease Activity Index scores than control patients. Compared with SLE patients with IPO, the patients with IPO and ureterohydronephrosis had a significantly higher incidence of gallbladder wall thickening, biliary tract dilatation, and serositis, whereas the patients with ureterohydronephrosis had less mucocutaneous involvement and serositis. Eight of the 47 IPO patients who initially responded well to immunotherapy relapsed; however, all responded well to retreatment with adequate immunotherapy. Of these 8 patients, 4 relapsed following poor compliance and self-discontinuation of steroid or immunosuppressant therapy. The rate of poor compliance with immunotherapy and the number of organ systems involved in patients in the recurrent IPO group were significantly higher than those in the nonrecurrent IPO group.IPO and ureterohydronephrosis are severe complications of SLE. As patients usually respond readily to early optimal steroid treatment, early diagnosis and timely initiation of glucocorticoid are important to relieve symptoms, prevent complications, and improve prognosis.

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Section: Discussioncontrasting

confidence: 64%

Clinical Analysis of 61 Systemic Lupus Erythematosus Patients With Intestinal Pseudo-Obstruction and/or Ureterohydronephrosis

Liu

et al. 2015

Medicine

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“…We summarize available clinical and immunological characteristics of CTD associated with CIPO and treated with octreotide in Table 1 [3–16]. Of 24 CTD patients with CIPO, there were 20 (83%) with SSc or SSc/PM overlap syndrome, and of the remaining 4 two had SLE, one PM, and one DM (the latter, our case reported here).…”

Section: Discussionmentioning

confidence: 99%

A Case of Dermatomyositis and Anti-EJ Autoantibody with Chronic Intestinal Pseudoobstruction Successfully Treated with Octreotide

Yamada

Sato

Sasaki

et al. 2016

Case Reports in Rheumatology

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Chronic intestinal pseudoobstruction (CIPO) is a serious complication in patients with connective tissue disease (CTD) and is sometimes life-threatening or fatal despite intensive medical treatment. Here, we report a patient with dermatomyositis (DM) and anti-EJ autoantibody who developed CIPO that was improved by octreotide. Because her abdominal pain and bloatedness were so severe and persistent, we introduced octreotide to relieve symptoms. In this case, continuous intravenous administration as well as long-acting subcutaneous injection of octreotide was effective for treating CIPO.

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“…Fewer than 30 cases of CIPO secondary to SLE have been reported so far, with the largest case series from Hong Kong. 5,8,9 It usually occurs in active SLE, although it could manifest during inactive SLE. 8 Mok et al reported that five out of six patients had CIPO as the first manifestation of SLE.…”

Section: Discussionmentioning

confidence: 99%

“…5,8,9 It usually occurs in active SLE, although it could manifest during inactive SLE. 8 Mok et al reported that five out of six patients had CIPO as the first manifestation of SLE. 5 In addition to CIPO, these patients also had concomitant glomerulonephritis (38.8%), thrombocytopaenia (27.8%) and autoimmune haemolytic anaemia (11.1%).…”

Section: Discussionmentioning

confidence: 99%

Chronic intestinal pseudo-obstruction: a rare first manifestation of systemic lupus erythematosus

Khairullah

Raja

Yahya

et al. 2013

Lupus

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Chronic intestinal pseudo-obstruction (CIPO) is a rare clinical syndrome of ineffective intestinal motility characterised by clinical and radiological evidence of intestinal obstruction with no identifiable mechanical lesion. CIPO can either be idiopathic or secondary to a systemic disease, like systemic lupus erythematosus (SLE). Fewer than 30 cases of CIPO secondary to SLE have been reported so far. Here we describe a case of SLE with the initial presentation of CIPO. In SLE-related CIPO, treatment includes a combination of high-dose intravenous corticosteroids, immunosuppressants and supportive care. With awareness of this condition, unnecessary surgical intervention and repeated invasive procedures could be avoided. Early initiation of treatment would avoid complications and bring about resolution of symptoms.

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Intestinal pseudo-obstruction in inactive systemic lupus erythematosus: An unusual finding

Cited by 11 publications

References 6 publications

Clinical Analysis of 61 Systemic Lupus Erythematosus Patients With Intestinal Pseudo-Obstruction and/or Ureterohydronephrosis

Clinical Analysis of 61 Systemic Lupus Erythematosus Patients With Intestinal Pseudo-Obstruction and/or Ureterohydronephrosis

A Case of Dermatomyositis and Anti-EJ Autoantibody with Chronic Intestinal Pseudoobstruction Successfully Treated with Octreotide

Chronic intestinal pseudo-obstruction: a rare first manifestation of systemic lupus erythematosus

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