Gastrointestinal perforation due to lupus enteritis in early-stage systemic lupus erythematosus

Lupus enteritis (LE) is an uncommon gastrointestinal (GI) manifestation of systemic lupus erythematosus (SLE) and GI perforation is a rare, but a severe complication of LE that is typically found in patients with high disease activity and a long disease duration. Herein, we present the case of a previously healthy 31-year-old Thai man who developed SLE complicated by LE. He was admitted to our hospital with refractory thrombocytopenia despite initial treatment with high-dose prednisolone, mycophenolate mofetil, and plasma exchange. Although the abdominal pain initially improved, residual pain persisted in the left side of the abdomen at the time of transfer. The abdominal pain gradually worsened despite starting rituximab therapy. Colonoscopy revealed extensive necrosis of the descending colon, and contrast-enhanced abdominal computed tomography revealed colonic perforation. Emergency surgery revealed ischaemia extending from the distal transverse, to an entirely perforated descending colon. Histopathological findings suggested that the colonic perforation was attributable to SLE-associated mesenteric vasculitis. The LE did not recur postoperatively. Because LE might lead to GI perforation even during the early stages of SLE, patients with high disease activity and persistent abdominal pain should be closely monitored, and treatment should be promptly escalated given the potential risk of perforation.