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Ulcerative colitis is a chronic inflammatory disorder of the colon characterized by continuous mucosal inflammation that typically begins in the rectum and extends proximally in a uniform pattern. Its pathogenesis involves a complex interplay of genetic predisposition, immune dysregulation, and environmental influences. These factors converge to impair the colon’s epithelial defenses and promote an exaggerated inflammatory response against luminal contents.Breakdown of the Mucosal...
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Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
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Inflammatory bowel disease is a group of chronic disorders marked by recurrent inflammation of the gastrointestinal tract due to an abnormal immune response against gut microflora. This leads to tissue damage. The two main forms are Crohn’s disease and ulcerative colitis.Crohn’s DiseaseCrohn’s disease is a relapsing inflammatory disorder that can affect any part of the GI tract, from the mouth to the anus. It involves all layers of the bowel wall (transmural) and shows...
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Chronic bowel diseases are a group of long-term conditions affecting the digestive tract, characterized by inflammation and damage to the gut lining. These conditions primarily include irritable bowel syndrome and inflammatory bowel disease.
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Systemic lupus erythematosus (SLE) can cause severe rectal ulcers. This case highlights successful treatment of SLE-related proctitis using intravenous methylprednisolone and cyclophosphamide, leading to symptom resolution and ulcer healing.

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Area of Science:

  • Gastroenterology
  • Rheumatology
  • Immunology

Background:

  • Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
  • Gastrointestinal involvement in SLE, particularly proctitis, is uncommon but can be severe.
  • Standard treatments for SLE may not always address gastrointestinal complications effectively.

Observation:

  • A 28-year-old woman with a history of SLE presented with a 2-month history of diarrhea, hematochezia, tenesmus, and rectal pain.
  • Laboratory findings showed active SLE with elevated anti-dsDNA and low complement levels (C3, C4).
  • Pelvic MRI revealed rectal wall thickening, and sigmoidoscopy demonstrated severe proctitis with deep ulcers and submucosal hemorrhage.

Findings:

  • Rectal biopsy confirmed crypt architectural distortion and reactive fibrosis, indicative of inflammatory bowel disease.
  • Initial treatment with mesalamine suppositories provided minimal relief.
  • Intravenous methylprednisolone followed by cyclophosphamide resulted in symptom resolution and fibrotic healing of rectal ulcers.

Implications:

  • This case underscores the importance of considering gastrointestinal manifestations in SLE patients presenting with lower gastrointestinal symptoms.
  • Aggressive immunosuppressive therapy, including cyclophosphamide, may be necessary for refractory SLE-related proctitis.
  • Prompt diagnosis and tailored treatment can lead to favorable outcomes and prevent complications in severe cases.