Lupus Enteritis: An Uncommon Presentation of Lupus Flare

Abstract

Gastrointestinal (GI) symptoms are common in systemic lupus erythematosus (SLE) but are usually attributable to medication side effects, infections, or other underlying conditions. In rare cases, they are caused by the autoimmune process itself. In this report, we present two cases of lupus enteritis as the sole manifestation of lupus flare. We also provide a comprehensive review of available literature on this topic with a specific focus on clinical symptoms, complications, laboratory findings, histology, imaging findings, and therapies. Lupus enteritis is an uncommon manifestation of SLE. CT scan of the abdomen is the diagnostic modality of choice. The three major CT findings are target sign, comb sign, and increased mesenteric fat attenuation. Ascites is also commonly present. Corticosteroids and second-line immunosuppressants have been successfully employed in the treatment of lupus enteritis. Our cases highlight this unusual manifestation as the only symptom of active SLE. A high index of suspicion should be maintained when evaluating SLE patients presenting with GI symptoms to prevent diagnosis and treatment delays that could lead to serious complications such as bowel necrosis, perforation, and even death.

Keywords: gastrointestinal symptoms; lupus enteritis; lupus flare; mesenteric vasculitis; systemic lupus erythematosus.

Figure 1. Contrast-enhanced abdominal CT scan - case 1

The scan revealed “target” or “double halo” sign (arrows) that represent circumferential thickening of the bowel wall secondary to submucosal edema. Both small and large intestines were affected in this case CT: computed tomography

Figure 2. Contrast-enhanced abdominal CT scan - case 2

Diffuse thickening of the small intestine and colon wall with target sign seen (arrows) CT: computed tomography