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• W2914296634 abstract "Background Lupus enteritis an uncommon complication of systemic lupus erythematosus(SLE) that could present like acute mesenteric ischemia(AMI) due to vasculitis of mesenteric arteries. Here we present an unusual cause of acute abdominal pain due to lupus enteritis. Case Presentation A 50-year-old female with a history of congestive heart failure(10-15%), Coronary artery disease, SLE who presented to the ER with acute onset abdominal pain for 3 days. Patient described the pain as epigastric, sharp pain, rating 10/10 and non radiating. This was associated with nausea and non-bloody emesis with fever and chills. Patient had prior admission to an outside hospital with similar complaints 2 months ago and was treated with prednisone with improvement in her symptoms. Patient's medications include enalapril, metoprolol, hydroxychloroquine, prednisone 20mg. Patients abdomen was soft, mildly tender in epigastric area without guarding. Lab work was significant for WBC was 10050/mcL, Lactate of 3.0 mg/dL and Lipase 28 U/L. C-reactive protein(CRP) of 180 mg/L. CT abdomen/pelvis showed bowel wall edema and hyperenchancement of the proximal jejunum with moderate distention along with minimal right paracolic ascites. Patient had a previous CT scan done 2 months earlier which showed duodenal wall thickening. Differential diagnosis included infectious vs inflammatory vs ischemic bowel. Her C4 complement levels were low at 4, which in addition to high CRP was suggestive of lupus flare, causing enteritis. Patient had routine infectious workup including blood and urine cultures which were negative. Patient was given prednisone 20 mg with dramatic improvement of her symptoms and she was discharged home.Figure: Target sign.Figure: Comb sign.Discussion Lupus enteritis an uncommon complication of SLE caused due to vasculitis of the small bowel. Lupus enteritis typically affects the jejunum and ileum and presents with acute abdominal pain, out of proportion to exam. This can be confused with acute mesenteric ischemia which has similar presentation. Diagnosis is made with CT which shows thickening of the bowel wall, enhancement of the bowel known as target sign, enlargement of the mesenteric vessels with discernable vessels known as Comb's sign. Other differential diagnosis includes inflammatory bowel disease, mechanical bowel obstruction, peritonitis and pancreatitis. Main stay of treatment is with prednisone for acute control of inflammation, which is usually associated with dramatic improvement of abdomen pain." @default.
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• W2914296634 date "2017-10-01" @default.
• W2914296634 modified "2023-09-27" @default.
• W2914296634 title "Lupus Enteritis: An Uncommon Cause of Abdominal Pain" @default.
• W2914296634 doi "https://doi.org/10.14309/00000434-201710001-02430" @default.
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