Systemic lupus erythematosus complicated by Crohn’s disease: a case report and literature review

Abstract

BackgroundAlthough patients with systemic lupus erythematosus (SLE) may experience various gastrointestinal disorders, SLE and Crohn’s disease (CD) rarely coexist. The diseases may have gastrointestinal (GI) manifestations, laboratory results, and radiographic findings that appear similar and consequently differentiating between GI involvement in CD and in SLE may be difficult. We present the case of a patient with SLE and CD who developed continuous GI bleeding and diarrhea that was initially treated as SLE-related colitis to little effect.Case presentationA 55-year-old Japanese woman with systemic lupus erythematosus (SLE) developed continuous gastrointestinal bleeding and diarrhea since the patient was aged 30 years that was initially treated as SLE-related colitis. Although a longitudinal ulcer and aphthous ulcers in the colon were observed every examination, biopsy showed only mild inflammation and revealed neither granuloma nor crypt abscess. The patient underwent surgery for anal fistulas twice at 50 and 54 years of age and her symptoms were atypical of lupus enteritis. Colonoscopy was performed again when the patient was 55 years of age because we suspected she had some type of inflammatory bowel disease (IBD). Cobblestone-like inflammatory polyps and many longitudinal ulcers were detected between the descending colon and the cecum. Macroscopic examination strongly suggested CD. Histopathological examination revealed non-caseating granuloma and no evidence of vasculitis, consistent with CD. Introduction of infliximab dramatically relieved the patient’s melena and abdominal symptoms.ConclusionDiagnostic criteria for CD and SLE overlap, making them difficult to diagnose correctly. It is important to consider CD for patients who have SLE with gastrointestinal manifestations. The pathology of lupus enteritis should be clarified through the accumulation of cases of SLE combined with CD.

Rheumatologic and extraintestinal manifestations of inflammatory bowel diseases

“…Concerning Systemic Sclerosis and SLE to date only few cases have been reported to be associated with UC (65,66) and CD (67,68).…”

Protein Spectrum Produced by the Dermal Fibroblasts in Children With Crohn’s Disease

“…К 5-му пассажу она была зарегистрирована только в кла-стере от 3,3 до 6,00 кДа (в 2 раза). Наблюдаемая повы-шенная активность дермальных фибробластов больных детей, вероятно, может быть объяснена тем, что болезнь Крона является системным заболеванием, затрагиваю-щим многие органы [11].…”

Coexistence of Systemic Lupus Erythematosus and Inflammatory Bowel Disease

“…SLE and IBD have common genetic susceptibilities [2,6,7], and IBD may occur incidentally in patients with SLE [7][8][9]. We identified 30 cases of concomitant SLE and IBD in the English and Japanese literature.…”

“…We identified 17 patients who developed concomitant SLE and CD; 11 in the English-language literature [1,2,[6][7][8][9][10][11][12][13][14][15] and 6 in the Japanese-language literature [16][17][18][19][20][21]. The patient characteristics are summarized in Table 1.…”

“…In total, 11 patients (65%) developed SLE before CD. Yamashita et al [9] reported that the mean time between SLE and CD development was 12 years among the 6 patients developing CD after SLE. In the 17 reported cases of concomitant SLE and CD, the time interval between the development of SLE and CD was 2-36 years.…”