Reversible acute gastrointestinal syndrome associated with active systemic lupus erythematosus in patients admitted to hospital

Abstract

Patients with systemic lupus erythematosus (SLE) frequently have gastrointestinal (GI) symptoms. These are usually self-limiting and related to treatment side-effects or concurrent illness. However, abdominal pain may be due to bowel ischaemia which can lead to infarction and perforation. The likelihood of these serious events is increased in individuals with pain severe enough to require assessment in hospital or a SLEDAI score > 5. This paper describes a group of patients with active SLE and GI symptoms severe enough to require admission to hospital using a retrospective review of 52 SLE patients admitted to hospital with acute abdominal symptoms. The results showed that abdominal pain (87%), vomiting (82%) and diarrhoea (67%) had been present for a mean of 4.4 +/- 6.5 days and SLEDAI score was > or = 4 in 83% of patients. CT scanning showed evidence of serositis and bowel involvement in 63% of patients who underwent this investigation. Intravenous (iv) fluids were used in 87%, parenteral steroids in 90% and iv cyclophosphamide in 31%. Most (n = 51) were discharged well. Recurrence of GI symptoms occurred in 12 patients. The conclusions are that active SLE may manifest as an acute gastrointestinal syndrome. Early diagnosis, bowel rest, supportive medical therapy and treatment with corticosteroids and/or immunosupressives can result in a good outcome.

Systemic lupus erythematosus with intestinal perforation: A case report

“…prevalence of lupus mesenteric vasculitis in patients with SLE has been reported to be 2.2-9.7% (14,15). Lupus mesenteric vasculitis is considered to be caused in patients with SLE by circulating autoantibodies that form an immune complex deposition in blood vessels, which can lead to the development of vasculitis and thrombosis of the vessels supplying the intestine.…”

The Gastrointestinal Manifestations of Systemic Lupus Erythematosus: A Survey of the Literature

“…Al-Hakeem review of 13 lupus patients presenting to the emergency room with abdominal pain found 9 needed emergent surgeries [128]. Lian noted of 52 patients with hospital admission for abdominal pain and associated symptoms, 63% had serotitis or other bowel involvement [129]. Zizic's study demonstrated the staggering morbidity/ mortality by looking at 140 SLE patients seeking emergency care for abdominal pain and finding 15 (11%) with signs and symptoms of acute abdomen with over a 50% (8/15) associated mortality [116].…”

Diarréia como manifestação inicial de lúpus eritematoso sistêmico

“…Marcos de Figueiredo Cardoso (1) , Denilson S. Franco (1) , Ana Caroline Sobral Melo (1) , Eduardo Paulino (1) , Janaína Luz Narciso-Schiavon (2) , Leonardo de Lucca Schiavon (2) , Luiz Carlos Latorre (3) , Fernando da Costa Buzzoleti (4) Resumo O lúpus eritematoso sistêmico (LES) é uma doença crônica que acomete principalmente mulheres entre a terceira e quinta década de vida, multissistêmica, freqüentemente afetando os rins e o sistema nervoso central. Os sintomas relacionados ao trato gastrintestinal, apesar de comuns, quando ocorrem abrindo o quadro clínico, raramente levam ao diagnóstico por causa de sua baixa especificidade.…”

“…Com diagnóstico diferencial amplo e usualmente uma história pobre com exame físico inespecífico, a investigação das diarréias crônicas torna-se complexa (3) . Quando o acometimento gastrintestinal está associado à atividade do LES, as causas a serem consideradas são a vasculite mesentérica e a enteropatia perdedora de proteínas (2,(4)(5)(6)(7) . A vasculite mesentérica pode estar presente em 0,2% a 60% dos pacientes com LES admitidos por dor abdominal, e o prognóstico é usualmente ruim por causa da presença de ulcerações, hemorragia, perfuração e infarto mesentérico (2,4,5) .…”

“…Entre os sintomas gastrintestinais associados ao LES, os mais freqüentes são dor abdominal (secundária a serosite ou vasculite intestinal), vômitos e diarréia (2) . Entretanto, diarréia como manifestação inicial do LES é incomum, motivo pelo qual se decidiu relatar o caso.…”