Mesenteric vasculitis as a rare initial presentation of systemic lupus erythematosus: A case report

Alshehri, Abdullah; Alhumaidi, Hanady Mohammed; Asseri, Yahia Modawi; Ahmed, Mohamed Elbagir K; Omer, Haider A

doi:10.4103/sjmms.sjmms_206_19

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…In our study, comparing with cSLE without LMV, the proportion of intestinal wall thickening, peritoneal effusion, mesenteric vascular enhancement, hydronephrosis with ureteral dilation, intestinal congestion, and gastric mucosal thickening in cSLE with LMV were increased. Among them, intestinal wall thickening was the most common, accounting for 95% of LMV according to literature reports [ 13 ]. In our study, all cSLE with LMV presented with intestinal wall thickening.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and prognosis of childhood-onset lupus mesenteric vasculitis as the initial presentation—a case–control study

Zhu,

Lai,

Liu

et al. 2023

Arthritis Res Ther

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Background Lupus mesenteric vasculitis (LMV) as initial presentation is rare, especially in childhood-onset systemic lupus erythematosus (cSLE). It is a critical complication of lupus. At present, the research on cSLE with LMV as the initial presentation is few. The aim of this study was to analyze the clinical characteristics and prognosis of cSLE with LMV in the Chinese population, compared with non-LMV cSLE. Methods A retrospective case-controlled study was conducted on 55 cSLE patients between July 2018 and July 2021. The clinical data, laboratory findings, imaging, treatment, and follow-up data were collected and compared between the two groups of cSLE with LMV and non-LMV. Non-LMV cSLE patients were matched according to the age and sex of LMV patients. Results A total of 11 cSLE patients with LMV as the LMV group and 44 cSLE patients without LMV as the non-LMV group were included. The average age of onset was 12.55 ± 1.57 years old, the male-to-female ratio was 2:9, and high disease activity was observed in the LMV group. Abdominal pain was most common in LMV. Compared with the non-LMV, the percentage of abdominal pain, vomiting, abdominal distension, and diarrhea was higher, and gastrointestinal tract, serous cavity, kidney, and lung damage were higher in the LMV group (P < 0.05). In abdominal-enhanced CT, the percentage of intestinal wall thickening, peritoneal effusion, mesenteric vascular enhancement, hydronephrosis with ureteral dilatation, intestinal congestion, and gastric mucosa thickening in the LMV group were higher than those in the non-LMV group (P < 0.05). The percentage of receiving methylprednisolone pulse combined with cyclophosphamide pulse therapy in LMV was higher than in non-LMV. The clinical symptoms disappeared quickly, and there were no deaths in the LMV group. Compared with the non-LMV group, the 24-h urinary protein was higher, the complement C3 was lower, and the disease activity was higher in the LMV group (P < 0.05). Conclusions LMV often occurs in 12 ~ 13-year-old girls with high disease activity of cSLE. Abdominal pain is the most common and more susceptible to damage to the kidney, serous cavity, and lung in cSLE with LMV. Methylprednisolone pulse combined with CTX pulse therapy is effective. After the treatment above, cSLE with LMV has a good prognosis, but the overall recovery is worse than non-LMV patients.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and prognosis of childhood-onset lupus mesenteric vasculitis as the initial presentation—a case–control study

Zhu,

Lai,

Liu

et al. 2023

Arthritis Res Ther

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“…SLE had different features and expressions in every organ, such as the skin, kidneys, joints, liver, pancreas, and GI system[ 12 , 13 ]. Various manifestations of vasculitis occur in association with SLE such as stomachache (97%), ascitic fluid (78%), sick (49%), vomitus (42%), diarrhoea (32%), mesenteric vasculitis, protein-losing enteropathy, intestinal pseudo-obstruction, intussusception, and bowel gangrene[ 14 , 15 ]. The diagnosis of SLE has been mostly proposed by the EULAR/ACR 2019 sorting criterion.…”

Section: Discussionmentioning

confidence: 99%

“…The percent of patients of GI tract related symptom is up to 40%-50%[ 14 ], but the development of LE is present in only about 0.2% to 5.8% of SLE patients[ 8 , 16 ]. LE involving the jejunum and ileum (83% and 84%, respectively) are relatively common[ 17 , 18 ], but involvement of the colon (19%) and rectum (4%) without involvement of the small intestine is extremely rare[ 14 ]. In previous reports, LE has been described as two types: Small intestine-dominant and large intestine-dominant.…”

Section: Discussionmentioning

confidence: 99%

Rare case of lupus enteritis presenting as colorectum involvement: A case report and review of literature

Gan,

Wang,

Gan

et al. 2023

World J Clin Cases

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BACKGROUND Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can affect the gastrointestinal tract. Most cases of lupus enteritis (LE) involve the small intestine, while the involvement of the whole colon and rectum without the small intestine being affected is extremely rare. CASE SUMMARY A 35-year-old woman was diagnosed with colorectal LE after initially presenting with intermittent abdominal pain and vomiting for two months. She had a regular medication history for five years following the diagnosis of SLE but had been irregular in taking medications, which may have contributed to the onset of LE and led to her current hospital admission. According to the 2019 Classification criteria for SLE of the European League Against Rheumatism/American College of Rheumatology, this case scored 14. Additionally, abdominal computed tomography revealed significant wall edema of the colon and rectum, ischemia and hyperemia of the ascending colon intestinal wall, mesenteric vessel engorgement, increased mesangial fat attenuation, ascites, and bilateral ureter-hydronephrosis, all indicative of colon and rectum LE. Laboratory tests also showed lower levels of complement C3 and C4, with an antinuclear antibody titer of 1:100. Overall, it was clear that this case involved the colon and rectum without affecting the small intestine, representing a rare manifestation of SLE. The patient received treatment with 10 mg of methylprednisolone sodium succinate, 100 mL of 0.9% sodium chloride, hydroxychloroquine (100 mg), and nutrition support. After one week of methylprednisolone and hydroxychloroquine therapy, her SLE symptoms and disease activity improved significantly. CONCLUSION Although colorectal LE without small intestine involvement is very rare, early diagnosis and excellent management with corticosteroids prevented the need for surgical intervention. Physicians should be aware of colorectal LE without small intestine involvement as a manifestation of lupus flare.

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“…While lupus mesenteric vasculitis (LMV) is prevalent in Asia and America, globally, it can range from 0.2% to 9.7% [ 2 ]. The clinical manifestations of LMV include abdominal pain, nausea, diarrhea, and fever [ 2 , 8 ]. However, in the patient’s case, there is a complaint of continuous burning pain in the epigastrium that does not improve with rest, change of position, or eating.…”

Section: Discussionmentioning

confidence: 99%

Severe Abdominal Pain and Multi-Organ Involvement in a Young Woman With Systemic Lupus Erythematosus

2023

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Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by diverse clinical manifestations and a broad spectrum of disease course and prognosis. Often presenting over an extended period, delays in diagnosis can significantly influence patient management and survival, particularly when faced with rare complications such as digestive system manifestations. This case report uniquely highlights the diagnostic and therapeutic challenges posed by severe abdominal pain in a young woman suspected of SLE, with a symptom often masked by steroid therapy or immunosuppression. The diagnostic journey, which led to the identification of SLE as the cause of abdominal pain, involved differentiating SLE from various abdominal pathologies including abdominal vasculitis, gastrointestinal syndrome, antiphospholipid antibody syndrome, pancreatitis, urinary tract infections, and obstetric-gynecological abnormalities. This case underlines the critical need for accurate, timely diagnosis, and targeted therapy in managing SLE, emphasizing the potential implications of such complexities on patient outcomes.

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Mesenteric vasculitis as a rare initial presentation of systemic lupus erythematosus: A case report

Cited by 4 publications

References 18 publications

Clinical characteristics and prognosis of childhood-onset lupus mesenteric vasculitis as the initial presentation—a case–control study

Clinical characteristics and prognosis of childhood-onset lupus mesenteric vasculitis as the initial presentation—a case–control study

Rare case of lupus enteritis presenting as colorectum involvement: A case report and review of literature

Severe Abdominal Pain and Multi-Organ Involvement in a Young Woman With Systemic Lupus Erythematosus

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