The patient, a 35-year-old woman, presented to our emergency department with a two-day history of epigastric tenderness with watery and blood-tinged stool. She had been diagnosed with systemic lupus erythematosus (SLE) with initial presentations of pancytopenia, serositis, heavy proteinuria, high-titer antinuclear antibodies, and elevated levels of anti–double-stranded DNA antibodies for one and a half years. Upon arrival of our hospital, physical examination revealed left–middle abdominal and epigastric pain without muscle guarding or rigidity. Stool testing revealed 4+ occult blood, but no fecal leukocytes or neutrophils were detected. Computed tomography of the abdomen with intravenous contrast revealed severe long-segmental concentric wall thickening of the small intestine with submucosal edema (A stars) and “bull's eye sign” (B red arrows). However, neither bowel ischemia nor perforation was found. Laboratory examinations demonstrated thrombocytopenia (61,000/mm3), hypocomplementemia (C3 = 17.7 mg/dL; C4 444 IU/mL). Antiphospholipid antibodies and antineutrophil cytoplasmic antibodies were undetectable. Active SLE associated intestinal vasculitis was diagnosed,1 and she subsequently received aggressive treatments with methylprednisolone pulse therapy (500 mg/day for three days), cyclophosphamide 400 mg as well as intravenous immunoglobulin injection (1 g/kg of body weight). The patient had a good clinical response without recurrence. Her lupus was well-controlled with prednisolone, mycophenolic acid, and hydroxychloroquine afterwards, and she has remained free of recurrence for over three years. Disclosure Form: Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Teng et al. (Sun,) studied this question.