Systemic lupus erythematosus with intestinal pseudo-obstruction and polyserositis complicated by pneumatosis intestinalis and pulmonary embolism: a unique challenge posed by a fatal combination

Systemic lupus erythematosus (SLE) is a multisymptomatic autoimmune rheumatic disease. Some complications are well known and can be life-threatening, such as pulmonary embolism (PE) and, in general, thrombotic events due to endothelial dysfunction, platelet activation, and secondary antiphospholipid syndrome. Gastrointestinal (GI) involvement is less prevalent and is not directly associated with a life-threatening risk. Hovewer, lupus mesenteric vasculitis, intestinal pseudo- obstruction (IPO), and enteropathy indicate that closer attention should be paid to these complications. Therefore, the aim of this review is to identify cases of SLE with IPO, pneumatosis intestinalis (PI), and PE in the current literature. The case of a patient with SLE and IPO became the stimulus for this research and discussion. Finally, after the selection process, 49 studies were reviewed and included in the analysis; as a result, the literature typically describes cases of IPO and PI, but only rare reports present an association of these complications with thrombotic events such as PE. In conclusion, research should focus more deeply on SLE patients with complex GI and thrombotic manifestations.