Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD, USA.
J Clin Rheumatol. 2013 Mar;19(2):84-6. doi: 10.1097/RHU.0b013e318284794e.
We report the case of a 25-year-old Iraqi woman who had multiple hospitalizations at an outside hospital for abdominal pain, nausea, and diarrhea without any evidence of systemic lupus erythematosus. Laboratory investigations finally showed a positive antinuclear antibody (1280), positive anti-dsDNA, anti-β2 glycoprotein I, low complement, positive Coombs tests, and leukopenia. A kidney biopsy showed ISN class II lupus nephritis. An ileal biopsy and angiogram were unremarkable. A computed tomography showed marked and dramatic bowel edema involving the small and large bowel ("target sign"), dilatation of intestinal segments, engorgement of mesenteric vessels ("comb sign"), and increased attenuation of mesenteric fat. These cardinal signs on computed tomography scan led to the correct diagnosis of lupus enteritis. Treatment was commenced with high-dose corticosteroids followed by mycophenolate mofetil, hydroxychloroquine, and then oral cyclophosphamide, but failed. The patient was eventually treated with the Euro-Lupus intravenous cyclophosphamide regimen, which resulted in significant clinical and radiological resolution.
我们报告了一例 25 岁的伊拉克女性病例，她因腹痛、恶心和腹泻多次在一家外院住院，但没有任何系统性红斑狼疮的证据。实验室检查最终显示抗核抗体（1280）阳性、抗双链 DNA、抗β2 糖蛋白 I、补体低、抗 Coombs 试验阳性和白细胞减少。肾脏活检显示 ISN 二级狼疮肾炎。回肠活检和血管造影无明显异常。计算机断层扫描显示明显而剧烈的肠壁水肿累及小肠和大肠（“靶征”）、肠段扩张、肠系膜血管充盈（“梳征”）和肠系膜脂肪衰减增加。这些计算机断层扫描上的主要征象导致了狼疮性肠炎的正确诊断。治疗开始时使用大剂量皮质类固醇，随后使用霉酚酸酯、羟氯喹，然后是口服环磷酰胺，但治疗失败。患者最终接受了 Euro-Lupus 静脉注射环磷酰胺方案治疗，结果临床和影像学明显缓解。
