Gan H, Wang F, Gan Y, Wen L. Rare case of lupus enteritis presenting as colorectum involvement: A case report and review of literature. World J Clin Cases 2023; 11(34): 8176-8183 [PMID: 38130788 DOI: 10.12998/wjcc.v11.i34.8176]
Corresponding Author of This Article
Li Wen, MD, PhD, Doctor, Department of Radiology, The Second Affiliated Hospital of Army Medical University, Xinqiao Hospital, Xinqiaozhengjie, Shapingba District, Chongqing 400037, China. cqzdwl@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 6, 2023; 11(34): 8176-8183 Published online Dec 6, 2023. doi: 10.12998/wjcc.v11.i34.8176
Rare case of lupus enteritis presenting as colorectum involvement: A case report and review of literature
Hui Gan, Fei Wang, Yuan Gan, Li Wen
Hui Gan, Li Wen, Department of Radiology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
Fei Wang, Department of Radiology, Luzhou People’s Hospital, Luzhou 646000, Sichuan Province, China
Yuan Gan, Department of Barracks Section, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
Author contributions: Gan H wrote the article; Wang F drew a diagram; Gan Y collected data; and Wen L revised the article.
Informed consent statement: Our study was approved by the Medical Ethics Committee of Xinqiao Hospital of Army Medical University (No. 2022-125-01), and informed consent has been obtained from the patient for the publication of cases and pictures.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li Wen, MD, PhD, Doctor, Department of Radiology, The Second Affiliated Hospital of Army Medical University, Xinqiao Hospital, Xinqiaozhengjie, Shapingba District, Chongqing 400037, China. cqzdwl@163.com
Received: August 29, 2023 Peer-review started: August 29, 2023 First decision: October 9, 2023 Revised: October 25, 2023 Accepted: November 24, 2023 Article in press: November 24, 2023 Published online: December 6, 2023 Processing time: 98 Days and 19.8 Hours
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.
Core Tip: According to the 2019 Classification criteria for systemic lupus erythematosus of the European League Against Rheumatism/American College of Rheumatology classification criteria, the score of this case was 14. In addition, computed tomography of abdomen showed marked and dramatic wall edema of the whole colon and rectum, ischemia and hyperemia of ascending colon intestinal wall, engorgement of mesenteric vessels, increased attenuation of mesenteric fat, ascites and bilateral ureter-hydronephrosis, demonstrating colon and rectum lupus enteritis (LE). Moreover, laboratory tests revealed lower complement C3 and C4. The titer of antinuclear antibody was 1:100. Overall, whole colon and rectum LE invaded of this case without involving small intestine was clear which was one of the rare manifestations of Systemic lupus erythematosus (SLE). The patient was treated with 10 mg methylprednisolone sodium succinate and 100 mL of 0.9% sodium chloride, hydroxychloroquine (100 mg) and nutrition support. After one week therapy of methylprednisolone and hydroxychloroquine, her symptoms and disease activity of SLE were dramatically improved.
