Recurrent Lupus Enteritis While on Chronic Immunosuppressant Therapy.

Area of Science:

• Gastroenterology
• Rheumatology
• Immunology

Background:

• Systemic lupus erythematosus (SLE) can manifest with gastrointestinal complications, including lupus enteritis, which is often underdiagnosed.
• Patients with SLE on long-term immunosuppressive therapy may present with abdominal pain, mimicking other conditions.
• Chronic immunosuppression can complicate the diagnosis of active lupus manifestations.

Observation:

• A 28-year-old female with a history of SLE and prior lupus enteritis presented with abdominal pain, vomiting, and diarrhea.
• Clinical presentation included skin rashes, leukopenia, hypocomplementemia, hematuria, and proteinuria.
• Abdominal CT revealed significant bowel wall thickening in the ileum, jejunum, and duodenum, with mesenteric edema and ascites.

Findings:

• Infectious etiologies were considered and ruled out in a patient on hydroxychloroquine and mycophenolate mofetil.
• The patient responded dramatically to intravenous methylprednisolone followed by oral prednisone.
• Repeat CT scan two months later demonstrated complete resolution of the small bowel wall thickening.

Implications:

• This case underscores that lupus enteritis should remain in the differential diagnosis for abdominal pain in SLE patients, irrespective of their immunosuppressive regimen.
• Early recognition and appropriate treatment with corticosteroids are crucial for managing lupus enteritis and preventing complications.
• Highlighting the importance of considering lupus enteritis in patients with SLE and abdominal symptoms, even those on chronic immunosuppression.