Systemic lupus erythematosus and intestinal venulitis

A 22-yr-old woman with a 7-yr history of systemic lupus erythematosus presented with anasarca and a serum albumin of 0.8 g/dl. Renal and hepatic function were near normal; the major route of protein loss appeared to be the intestine. A full-thickness section of jejunum obtained at laparotomy demonstrated a severe, diffuse vasculitis involving the venules of the submucosa and muscularis externa with infiltration of polymorphonuclear leukocytes and macrophages, and deposits of C3. There was a similar focal damage of the walls of the small vessels in the lamina propria, and deposits of C3 and fibrinogen in a thickened basement membrane of the intestinal villi. This report documents that in systemic lupus erythematosus the intestine can be affected with a vasculitis similar to that seen in the skin and can cause thickening of the basement membrane of intestinal villi. These lesions may be responsible for protein-losing enteropathy.