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Severe Lupus Enteritis Complicated by Intractable Gastrointestinal Hemorrhage
Austin Thomas1, Clay Smithhart1, Maneera Chopra1
1Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, TX.
ACG Case Reports Journal
|November 6, 2023
Summary
Lupus enteritis (LE), a rare lupus complication, can cause severe bleeding and anemia. Prompt specialist care with IV immunoglobulin and plasmapheresis is crucial for life-threatening cases.
Area of Science:
- Gastroenterology
- Rheumatology
- Immunology
Background:
- Lupus enteritis (LE) is an uncommon gastrointestinal manifestation of systemic lupus erythematosus (SLE).
- It presents with nonspecific symptoms and can lead to severe complications like bowel perforation and hemorrhage.
- Standard treatment with glucocorticoids may not suffice in severe cases.
Observation:
- A case of severe LE complicated by intractable gastrointestinal hemorrhage and warm autoimmune hemolytic anemia is presented.
- The patient's condition was refractory to initial glucocorticoid therapy.
- This necessitated aggressive management including massive transfusions, intravenous immunoglobulin (IVIg), and plasmapheresis.
Findings:
- Severe LE can manifest with life-threatening gastrointestinal bleeding and autoimmune hemolytic anemia.
- Refractory cases require advanced immunosuppressive therapies beyond standard glucocorticoids.
- Early recognition and multidisciplinary specialist involvement are critical for managing severe LE.
Implications:
- This case highlights the potential severity of lupus enteritis and its associated complications.
- Intravenous immunoglobulin and plasmapheresis represent vital treatment options for refractory, life-threatening LE.
- Emphasizes the need for early specialist consultation in managing complex lupus manifestations.
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