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Case Reports
. 2019 Jul;98(28):e16178.
doi: 10.1097/MD.0000000000016178.

Lupus intestinal pseudo-obstruction and hydronephrosis: Case report

Brittany L Adler  1 , Homa Timlin, Julius Birnbaum
Affiliations
Case Reports

Lupus intestinal pseudo-obstruction and hydronephrosis: Case report

Brittany L Adler et al. Medicine (Baltimore). 2019 Jul.

Abstract

Introduction: Intestinal pseudo-obstruction (IPO) is a rare and life-threatening complication of lupus.

Patient concerns: A patient with long-standing lupus developed recurrent abdominal pain and distension as well as nausea and emesis.

Diagnosis: Imaging showed dilated small bowel loops with air-fluid levels and bowel wall thickening. She also had bilateral hydronephrosis.

Interventions: She was given high-doses of intravenous steroids and cyclophosphamide.

Outcomes: Her symptoms resolved within a week of starting immunosuppression. She was eventually transitioned to mycophenolate mofetil. She remained in remission and immunosuppression was successfully stopped after 1 year.

Conclusions: Intestinal pseudo-obstruction is a rare complication of lupus that is often seen in association with ureterohydronephrosis and interstitial cystitis. This clinical syndrome is thought to be because of smooth muscle dysmotility of the gastrointestinal and genitourinary tracts, although the exact mechanism of dysmotility remains unknown. This condition is often responsive to immunosuppression if recognized and treated promptly.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Large dilated bowel loops and bowel wall thickening in lupus intestinal pseudo-obstruction.
Figure 2
Figure 2
Bilateral hydronephrosis associated with lupus intestinal pseudo-obstruction.
See this image and copyright information in PMC

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References

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