Recurrent Lupus Enteritis While on Chronic Immunosuppressant Therapy

Lupus enteritis is a poorly studied cause of abdominal pain in patients with systemic lupus erythematosus (SLE). We present the case of a 28-year-old female with a history of SLE for nine years. She has been on chronic immunosuppressant therapy for the last nine years due to an episode of lupus enteritis in the past. Currently, the patient presented to urgent care with a three-day history of waxing and waning symptoms of abdominal pain, vomiting, and diarrhea. In addition, the patient had skin rashes. Laboratory work was significant for leukopenia, hypocomplementemia, hematuria, and proteinuria. CT of the abdomen showed bowel thickening involving the entire ileum, distal jejunum, and first portion of the duodenum. It was accompanied by moderate mesenteric edema and a small amount of ascites. Since the patient was on long-term immunosuppressive therapy with hydroxychloroquine and mycophenolate mofetil, infectious etiology was of high consideration; however, it was ruled out after further testing. Along with continuing her home dose of mycophenolate mofetil and hydroxychloroquine, the patient was started on IV methylprednisolone 1 mg/kg for three days. The patient dramatically responded to IV steroids. The patient was transitioned to oral prednisone 60 mg daily, and steroids were tapered off by 10 mg each week. A repeat CT scan in two months showed the resolution of the previously visualized small bowel wall thickening. This case highlights that chronic immunosuppression should not preclude differential or diagnosis of lupus enteritis in a patient with a history of SLE.