Delayed Recognition of Systemic Lupus Erythematosus Presenting With Visceral Muscle Dysmotility and Chronic...

BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organ systems. Visceral muscle dysmotility syndrome (VMDS) is a rare gastrointestinal manifestation of SLE that is often underrecognized. It usually presents with acute abdominal pain, vomiting, or constipation. Chronic mucus-bloody diarrhea as the initial manifestation of SLE has not been previously reported. CASE REPORT A 20-year-old woman presented with persistent mucus-bloody diarrhea and subacute fever. Before admission, she was diagnosed with infectious enteritis and received empiric antibiotic therapy for 1 week without clinical improvement. She was subsequently referred to the emergency department with high-grade fever and dyspnea. Initial clinical findings did not suggest SLE. Extensive infectious workup results were negative. Computed tomography of the entire abdomen later demonstrated diffuse circumferential wall thickening of the stomach, entire bowel, and urinary bladder, findings suspicious for VMDS. Colonoscopy revealed diffuse mucosal edema consistent with systemic inflammation. The patient fulfilled the diagnostic criteria for SLE with high disease activity, including lupus nephritis and neuropsychiatric lupus. Systemic corticosteroid therapy was promptly initiated, and antibiotics were discontinued. Her gastrointestinal symptoms resolved. However, delayed recognition contributed to generalized brain atrophy evident at the time of diagnosis. CONCLUSIONS Chronic mucus-bloody diarrhea may be the initial manifestation of SLE. This case underscores the importance of considering autoimmune etiologies in patients with unexplained inflammatory bowel-like symptoms and promptly excluding infection. Early recognition of lupus enteritis and VMDS is essential to initiate aggressive immunosuppressive therapy and prevent irreversible organ damage.