Bowel symptoms occur often in systemic lupus erythematosus (SLE), but enteric complications in patients on steroid therapy are rare. We report a case of a 14-year-old Mexican girl with SLE on high-dose steroid therapy complicated by abdominal vasculitis and small bowel perforation. Accompanying this serious complication were thrombocytopenia and radiographic changes of pneumatosis intestinalis. These findings suggested necrotizing enteritis and prompted urgent surgery. Four jejunal perforations, pneumatosis intestinalis, and submucosal vasculitis were present in the resected specimen. Persistent SLE activity responded to cyclophosphamide, which is indicated in patients with digestive symptoms who fail to respond to high-dose steroids.
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References
1.
ZizicTM, ClassenJN, StevensMB. Acute abdominal complications of systemic lupus erythematosus and polyarteritis nodosa. Am J Med1982;73:525–31.
2.
ShapeeroLG, MyersA, OberkircherPE, MillerWT. Acute reversible lupus vasculitis of the gastrointestinal tract. Radiology1974;112:569–74.
3.
Alarcón-SegoviaD, CardielMA. Connective tissue disorders and the bowel. Baillieres Clin Rheumatol1989;3:371–92.
4.
HoffmanBI, KatzWA. The gastrointestinal manifestations of systemic lupus erythematosus: A review of the literature. Semin Arthritis Rheumatism1980;9:237–47.
5.
BrownCH, ShireyEK, HaserickJR. Gastrointestinal manifestations of systemic lupus erythematosus. Gastroenterology1956;31:649–66.
MatoloNM, AlboDJr. Gastrointestinal complications of collagen vascular disease: Surgical implications. Am J Surg1971;122:678–82.
8.
PollackVE, GroveWJ, KarkRM, . Systemic lupus erythematosus simulating acute surgical condition of the abdomen. N Engl J Med1958;259:258–66.
9.
Case records of The Massachusetts General Hospital (45202). N Engl J Med1959;260:1035–9.
10.
DuboisEL. Lupus Erythematosus: A Review of the Current Status of Discoid and Systemic Lupus Erythematosus and Their Variants, Ed. 2. Los Angeles, University of Southern California1974, p 284.
11.
YeattsRP, TurnerR, CollinsR, . Soluble and insoluble immune complex-platelet interactions in rheumatoid inflammation. Ann Rheum Dis1978;37:421–7.
12.
ZizicTM, StevensMB, ClassenJN. Abdominal syndromes in systemic lupus (SLE) and polyarteritis (PA): Predisposing factors. Arthritis Rheum1978;21:606.
13.
LüscherEF, PfuellerSL, MassiniP. Platelet aggregation by large molecules. Ser Haematol1973;6:382–91.
14.
PruittRE, TumminelloW, ReveilleJD. Pneumatosis cystoides intestinalis and benign pneumoperitoneum in a patient with antinuclear antibody negative systemic lupus erythematosus. J Rheumatol1988;15:1575–7.
15.
FreimanD, ChonH. Bilaniuk L. Pneumatosis intestinalis in systemic lupus erythematosus. Radiology1975;116:563–4.
16.
KleinmanP, MeyersMA, AbbotG, KazamE. Necrotizing enterocolitis with pneumatosis intestinalis in systemic lupus erythematosus and polyarteritis. Radiology1976;121:595–8.
17.
LaingTJ. Gastrointestinal vasculitis and pneumatosis intestinalis due to systemic lupus erythematosus: Successful treatment with pulse intravenous cyclophosphamide. Am J Med1988;85: 555–8.
18.
Carbajal-RodriguezL, Perea-MartinezA, Oldak-SkvirskyD, . Complicaciones abdominales en el lupus eritematoso sistémico. Bol Med Hosp Inf Mex1991;48:178–84.
19.
CabreraGE, ScopelitisE, CuellarML, . Pneumatosis cystoides intestinalis in systemic lupus erythematosus with intestinal vasculitis: Treatment with high dose prednisone. Clin Rheumatol1994;13:312–6.
20.
DecropE, PonetteE, BaertAL, . Pre-operative radiological diagnosis of acute necrotizing enteritis in systemic lupus erythematosus. J Beige Radiol1990;73:31–5.
21.
EberhardA, ShoreA, SilvermanE, LaxerR. Bowel perforation and cystitis in childhood systemic lupus erythematosus. J Rheumatol1991;18:746–7.
