Luís Mariana, Brites Ana Luísa, Duarte Ana Catarina, Teixeira Vitor, Freitas Raquel, Oliveira-Ramos Filipa, Macieira Carla, Santos Maria José, Inês Luís
Centro Hospitalar e Universitário de Coimbra.
Hospital Garcia de Orta.
Acta Reumatol Port. 2019 Apr-Jun;44(2):145-150.
Lupus enteritis (LE) is a rare, potentially life-threatening manifestation of systemic lupus erythematosus (SLE). Early diagnosis is crucial for early treatment and prevention of serious complications such as ischemic enteritis, bowel infarction with bleeding and/or perforation and peritonitis. The objective of this case review is to identify strategies for early diagnosis of LE.
Retrospective analysis of patients with SLE (fulfilling ACR 1997 and/or SLICC classification criteria) and presenting LE from three tertiary SLE centers was conducted. The diagnosis was based on clinical and imaging features consistent with LE and exclusion of other causes of GI disorders.
We report seven cases of LE (female: 100%; age range: 16-55 years). All presented with acute onset abdominal pain, nausea and vomiting at the emergency room. Two patients had lupus enteritis as inaugural manifestation of SLE. Of the remaining five, one presented at the previous visit to the lupus clinic with clinically active disease and two had serologically active/ clinically inactive SLE. High anti-dsDNA antibodies and low serum complement were universally present at time of the LE event. Abdominal ultrasound was the first imaging exam to be performed in the emergency room. In all cases it showed bowel wall thickening, dilatation of intestinal segments, increased reflectivity of mesenteric fat and mild ascites, raising the suspicion of LE and immediate start of treatment. These features were later confirmed by CT scan in five patients.
Despite being rare, LE must always be considered in any SLE patient presenting with GI symptoms. Abdominal ultrasound can be a reliable first line diagnostic tool for LE.
狼疮性肠炎（LE）是系统性红斑狼疮（SLE）一种罕见的、可能危及生命的表现形式。早期诊断对于早期治疗以及预防诸如缺血性肠炎、伴有出血和/或穿孔的肠梗死及腹膜炎等严重并发症至关重要。本病例回顾的目的是确定狼疮性肠炎的早期诊断策略。
对来自三个三级SLE中心的符合SLE（满足美国风湿病学会1997年和/或系统性红斑狼疮国际协作临床联盟分类标准）且出现狼疮性肠炎的患者进行回顾性分析。诊断基于与狼疮性肠炎一致的临床和影像学特征，并排除胃肠道疾病的其他病因。
我们报告了7例狼疮性肠炎病例（女性：100%；年龄范围：16 - 55岁）。所有患者在急诊室均表现为急性腹痛、恶心和呕吐。2例患者狼疮性肠炎为SLE的首发表现。其余5例中，1例在之前就诊于狼疮门诊时患有临床活动期疾病，2例患有血清学活动/临床非活动期SLE。在狼疮性肠炎发作时普遍存在高抗双链DNA抗体和低血清补体。腹部超声是急诊室首先进行的影像学检查。在所有病例中，它均显示肠壁增厚、肠段扩张、肠系膜脂肪回声增强及轻度腹水，从而引发对狼疮性肠炎的怀疑并立即开始治疗。这些特征后来在5例患者中经CT扫描得以证实。
尽管狼疮性肠炎罕见，但任何出现胃肠道症状的SLE患者都必须始终考虑到该病。腹部超声可为狼疮性肠炎提供可靠的一线诊断工具。
