Systemic lupus erythematosus with intestinal perforation: A case report

Gu, Yuqing; Zhu, Tao; Wang, Yiqing; Xu, Hongqi

doi:10.3892/etm.2015.2639

Cited by 9 publications

(10 citation statements)

References 22 publications

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“…Subacute lupus erythematosus (SCLE) is a specific form of lupus erythematosus, in which patients primarily exhibit cutaneous manifestations and typically have a good prognosis ( 14 , 15 ). SCLE is an autoimmune disease ( 16 ) characterized by the excessive production of autoantibodies by activated B cells and autoreactive T cells ( 17 , 18 ). SCLE is characterized by annular or psoriasiform cutaneous lesions located above the waist (neck, trunk and outer aspect of the arms) ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Drug-induced Rowell syndrome, a rare and difficult to manage disease: A case report

et al. 2017

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Rowell syndrome is defined as the association between lupus erythematosus, erythema multiforme-like lesions and characteristic immunological changes including positive tests for rheumatoid factor, speckled antinuclear antibody, positive anti-Ro or anti-La antibodies. The present report presents the case of a 45-year-old female patient who was previously diagnosed in January 2010 with terbinafine-induced subacute cutaneous lupus erythematosus and was admitted for a skin eruption consisting of erythematous-papular erythema multiforme-like lesions, primarily on the trunk and limbs. The associated symptoms consisted of fatigability, myalgia and gonalgia. In October 2015, the illness reoccurred ~1 week after the initiation of Helicobacter pylori eradication treatment. Anti-Ro antibodies, rheumatoid factor and antinuclear antibody tests were positive. Given the patient's medical history, clinical manifestations, and laboratory, histopathological and immunofluorescence microscopy findings, a diagnosis of Rowell syndrome was made. Systemic corticosteroids (methylprednisolone; 0.5 mg/kg/day) and immunomodulatory therapy (azathioprine; 50 mg/day) were administered with the associated medication (omeprazole, 20 mg/day; KCl, 1 g/day) and topical dermocorticoids (fluticasone propionate 0.05% cream; 1 application/day), with a favorable outcome. The major diagnostic criteria for Rowell syndrome are the presence of lupus erythematosus (acute, subacute or systemic), erythema multiforme-like lesions and positive testing for antinuclear antibodies. The minor diagnostic criteria for Rowell syndrome are chilblains, the presence of anti-Ro antibodies and positive testing for rheumatoid factor. A diagnosis of Rowell syndrome is made if the patient exhibits all major criteria and at least one minor criterion. The present case met all diagnostic criteria, excluding the presence of chilblains. Notably, in this case there was a co-occurrence of subacute lupus erythematosus and Rowell syndrome lesions, which was drug-induced.

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Section: Discussionmentioning

confidence: 99%

Drug-induced Rowell syndrome, a rare and difficult to manage disease: A case report

et al. 2017

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“…In the literature, there are less than 150 cases reported until 2018 [4]. Although intestinal perforation in systemic lupus erythematosus (SLE) patients are reported, we describe a unique case of SP in an SLE patient caused by fecaloma [4,5]. To the best of our knowledge, this is the first case reported in English medical literature.…”

Section: Introductionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

“…Intestinal perforation has been described in SLE patients on immunosuppressive medications [4,5]. In SLE, bowel perforation occurs because of lupus mesenteric vasculitis, which causes thrombosis of vessels resulting in infarction of the bowel wall and perforation, especially of the small bowel [5]. Another proposed mechanism is due to steroid use in SLE resulting in an immunocompromised state leading to CMV infection leading to ulceration of the bowel wall and perforation [9].…”

Section: Discussionmentioning

confidence: 99%

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Stercoral Perforation of Sigmoid Colon in Systemic Lupus Erythematosus: A Rare Cause of Peritonitis

Latif¹,

Musthafa²,

Ahmed³

et al. 2020

Cureus

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Stercoral perforation (SP) is a rare cause of peritonitis. It is caused by pressure necrosis of the colonic wall by fecaloma. SP is a lethal condition that is associated with high morbidity and mortality, therefore early diagnosis and treatment are of paramount importance. Herein, we describe a case of SP in a systemic lupus erythematosus (SLE) patient. A 44-year-old female, known case of SLE, presented with severe abdominal pain, fever, and hypotension. CT scan showed features of perforated sigmoid. The patient underwent exploratory laparotomy which revealed perforation of sigmoid, fecalomas in the peritoneal cavity, and colon loaded with fecal matter. The patient underwent Hartmann's operation with successful control of her intra-abdominal sepsis. Her postoperative course was complicated by SLE flare and wound dehiscence which was probably due to long term steroid use. Even though SP is rare, it carries a worse prognosis especially if the patients are immunocompromised. The key to successfully manage such cases is early diagnosis, aggressive resuscitation, antibiotics, and prompt surgical intervention. A multidisciplinary approach is often helpful in such cases.

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“…IPO can eventually progress into acute ischaemic enteritis leading to perforation 11. Perforations are life threatening as most SLE cases have had long-term immunosuppression and are surgically at greater risk of complications.…”

Section: Discussionmentioning

confidence: 99%

Lupus causing small bowel obstruction

et al. 2018

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A 20-year-old female patient was admitted to hospital in 2015 with 1 year history of recurrent abdominal pain, distension, borborygmi and nausea. The patient had a background of systemic lupus erythematous (SLE) diagnosed 4 years before, with skin, joint and renal involvement. The initial investigations have shown a long segment of ileal inflammation with upstream obstruction. Differential diagnoses were mainly SLE enteritis or concomitant Crohn’s. Patient failed the initial conservative management and had a laparotomy with small bowel (SB) resection and ileostomy. The histology was suggestive of autoimmune enteritis. Although bowel involvement is a frequent feature of SLE, surgery for obstruction is extremely rare. Postoperatively, she had an emergency admission and was diagnosed with SB volvulus with perforation. She underwent further resection and stoma refashioning in 2016. As a consequence, she developed short gut syndrome. Eventually, the stoma was reversed and parenteral nutrition was stopped and weight became stable.

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Systemic lupus erythematosus with intestinal perforation: A case report

Cited by 9 publications

References 22 publications

Drug-induced Rowell syndrome, a rare and difficult to manage disease: A case report

Drug-induced Rowell syndrome, a rare and difficult to manage disease: A case report

Stercoral Perforation of Sigmoid Colon in Systemic Lupus Erythematosus: A Rare Cause of Peritonitis

Lupus causing small bowel obstruction

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