Rare case of lupus enteritis presenting as colorectum involvement: A case report and review of literature

Abstract

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can affect the gastrointestinal tract. Most cases of lupus enteritis (LE) involve the small intestine, while the involvement of the whole colon and rectum without the small intestine being affected is extremely rare.

Case summary: A 35-year-old woman was diagnosed with colorectal LE after initially presenting with intermittent abdominal pain and vomiting for two months. She had a regular medication history for five years following the diagnosis of SLE but had been irregular in taking medications, which may have contributed to the onset of LE and led to her current hospital admission. According to the 2019 Classification criteria for SLE of the European League Against Rheumatism/American College of Rheumatology, this case scored 14. Additionally, abdominal computed tomography revealed significant wall edema of the colon and rectum, ischemia and hyperemia of the ascending colon intestinal wall, mesenteric vessel engorgement, increased mesangial fat attenuation, ascites, and bilateral ureter-hydronephrosis, all indicative of colon and rectum LE. Laboratory tests also showed lower levels of complement C3 and C4, with an antinuclear antibody titer of 1:100. Overall, it was clear that this case involved the colon and rectum without affecting the small intestine, representing a rare manifestation of SLE. The patient received treatment with 10 mg of methylprednisolone sodium succinate, 100 mL of 0.9% sodium chloride, hydroxychloroquine (100 mg), and nutrition support. After one week of methylprednisolone and hydroxychloroquine therapy, her SLE symptoms and disease activity improved significantly.

Conclusion: Although colorectal LE without small intestine involvement is very rare, early diagnosis and excellent management with corticosteroids prevented the need for surgical intervention. Physicians should be aware of colorectal LE without small intestine involvement as a manifestation of lupus flare.

Keywords: Case report; Colon and rectum; Comb sign; Lupus enteritis; Methylprednisolone and hydroxychloroquine; Systemic lupus erythematosus; Target sign.

Figure 1

Contrast-enhanced computed tomography scan of our patient shows severe whole colon and rectum wall thickening, with the target sign or doughnut sign (white arrows). A: The image shows the air-liquid level in the ascending colon, increased attenuation of mesenteric fat (white arrows head); B: The image shows the hyperemic ascending colon with obvious enhancement (white arrows head) and punctured gas breaking through the intestinal wall (white arrows); C: The image shows the ascending colon with ischemic and congestive changes in the same ascending bowel, which the hyperemic area showed obvious enhancement (white arrows head), and bilateral ureter-hydronephrosis (white arrows); D: The image shows rectum and sigmoid colon wall thickening with doughnut sign (white arrows), and ascites (white arrows head); E: The reconstructed coronal image shows mesenteric vessels enlargement with comb sign (white arrows).

Figure 2

Contrast-enhanced computed tomography scan of our patient shows all colon is normal after one week of treatment (white arrows).

Figure 3

The treatment process for this case. CT: Computed tomography.