1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University of Ioannina, PO Box 1186, 45110 Ioannina, Greece.
Rheumatol Int. 2013 Aug;33(8):2145-8. doi: 10.1007/s00296-011-2357-1. Epub 2012 Jan 15.
The concurrence of inflammatory bowel disease with systemic lupus erythematosus (SLE) is rare. The concomitant diagnosis of Crohn's disease and SLE is even more rare. The patient, a 40-year-old woman, was admitted to our hospital because of relapsing episodes of abdominal pain, diarrheas upper and lower extremities arthralgias, Raynaud's phenomenon with positive antinuclear antibodies, and fever for the last 2 years. The patient was diagnosed elsewhere with SLE and treated with hydroxychloroquine. Her medical history also included tonsillectomy and total hip replacement after a car accident. Family history was unremarkable. Physical examination was unremarkable except of very mild pain at lower left abdominal quadrant. Laboratory tests showed erythrocyte sedimentation rate at 32 mm/h, C-reactive protein at 36 mg/dl, positive rheumatoid factor, and increased C3, C4, positive antinuclear antibodies with the presence of anti-Sm and anti-RNP antibodies. Ileocolonoscopy revealed colonic inflammation with ulcers and pseudopolyps. Subsequent biopsies were diagnostic of Crohn's disease. Patient was diagnosed with Crohn's colitis concomitant to systemic lupus erythematosus and was started on therapy with azathioprine 2 mg/Kg, methylprednisolone 16 mg/d with slow tapering, mesalazine 1.5 g/day, and hydroxychloroquine. Patient is in excellent health status on the six-month follow-up.
炎症性肠病合并系统性红斑狼疮（SLE）较为罕见，同时合并克罗恩病和系统性红斑狼疮则更为罕见。该患者为 40 岁女性，因腹痛反复发作、腹泻、上下肢关节痛、雷诺现象伴抗核抗体阳性和发热 2 年就诊于我院。患者曾于外院被诊断为 SLE，并接受羟氯喹治疗。其病史还包括扁桃体切除术和车祸后全髋关节置换术。家族史无特殊。体格检查除左下腹部有轻微疼痛外无明显异常。实验室检查示红细胞沉降率 32mm/h，C 反应蛋白 36mg/dl，类风湿因子阳性，C3 和 C4 升高，抗核抗体阳性，存在抗 Sm 和抗 RNP 抗体。结肠镜检查显示结肠炎症伴溃疡和假息肉。随后的活检诊断为克罗恩病。该患者被诊断为同时患有克罗恩病合并系统性红斑狼疮，给予硫唑嘌呤 2mg/kg、甲泼尼龙 16mg/d 逐渐减量、美沙拉嗪 1.5g/d 和羟氯喹治疗。目前患者在 6 个月的随访中身体状况良好。
