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Bilateral Ureterohydronephrosis after Intestinal Pseudo-obstruction in a Patient with Systemic Lupus Erythematosus. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2022; 3:211-212. [PMID: 36879835 PMCID: PMC9984930 DOI: 10.2478/rir-2022-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/11/2022] [Indexed: 02/10/2023]
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Alsolaimani R. Mesenteric Vasculitis and Urinary System Involvement Presenting As the Initial Manifestations of Systemic Lupus Erythematosus Treated Successfully With Glucocorticoids and Rituximab: A Case Report. Cureus 2022; 14:e31474. [DOI: 10.7759/cureus.31474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
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Alharbi S. Gastrointestinal Manifestations in Patients with Systemic Lupus Erythematosus. Open Access Rheumatol 2022; 14:243-253. [PMID: 36281321 PMCID: PMC9587305 DOI: 10.2147/oarrr.s384256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder of unknown etiology. Women of childbearing age are affected approximately nine times more often than men. Its presentation and course are highly variable, ranging from mild to fulminant systemic disease. Any organ can be affected by SLE. Although less common than in other systems, such as the skin, joints, and kidneys, 40%–60% of SLE patients have gastrointestinal (GI) involvement. SLE can affect any part of the GI tract, from the mouth to the anus. GI manifestations can be caused by SLE, medication-related side effects, or non-SLE causes including infection. This article reviews the most common types of GI involvement associated with SLE.
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Affiliation(s)
- Samar Alharbi
- Department of Medicine, College of Medicine, Taibah University, Medina, Saudi Arabia,Correspondence: Samar Alharbi, Department of Medicine, College of Medicine, Taibah University, Medina, 42312-3779, Saudi Arabia, Tel +96 6553018777, Fax +96 648461172, Email
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Zhang W, Huang G, Lin J, Lin Q, Zheng K, Hu S, Zheng S, Du G, Matucci-Cerinic M, Furst DE, Wang Y. Predictive model of risk and severity of enteritis in systemic lupus erythematosus. Lupus 2022; 31:1226-1236. [PMID: 35750508 DOI: 10.1177/09612033221110743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To describe the clinical and laboratory features of systemic lupus erythematosus (SLE) enteritis and to establish a predictive model of risk and severity of lupus enteritis (LE). METHODS Records of patients with SLE complaining about acute digestive symptoms were reviewed. The predictive nomogram for the diagnosis of LE was constructed by using R. The accuracy of the model was tested with correction curves. The receiver operating characteristic curve (ROC curve) program and a Decision curve analysis (DCA) were used for the verification of LE model. Receiver operating characteristic curve was also employed for evaluation of factors in the prediction of severity of LE. RESULTS During the eight year period, 46 patients were in the LE group, while 32 were in the non-LE group. Abdominal pain, emesis, D-dimer >5 μg/mL, hypo-C3, and anti-SSA positive remained statistically significant and were included into the prediction model. Area under the curve (AUC) of ROC curve in this model was 0.909. Correction curve indicated consistency between the predicted rate and actual diagnostic rates. The DCA showed that the LE model was of benefit. Forty-four patients were included in developing the prediction model of LE severity. Infection, SLE disease activity index (SLEDAI), CT score, and new CT score were validated as risk factors for LE severity. The AUC of the combined SLEDAI, infection and new CT score were 0.870. CONCLUSION The LE model exhibits good predictive ability to assess LE risk in SLE patients with acute digestive symptoms. The combination of SLEDAI, infection, and new CT score could improve the assessment of LE severity.
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Affiliation(s)
- Weijin Zhang
- Department of Rheumatology and Immunology, 499791Shantou Central Hospital, Shantou, China
| | - Guohai Huang
- Department of Blood Purification, 499791Shantou Central Hospital, Shantou, China
| | - Jianqun Lin
- Department of Rheumatology and Immunology, 499791Shantou Central Hospital, Shantou, China
| | - Qisheng Lin
- Department of Rheumatology and Immunology, 499791Shantou Central Hospital, Shantou, China
| | - Kedi Zheng
- Department of Rheumatology and Immunology, 499791Shantou Central Hospital, Shantou, China
| | - Shijian Hu
- Department of Rheumatology and Immunology, 499791Shantou Central Hospital, Shantou, China
| | - Shaoyu Zheng
- Department of Rheumatology and Immunology, 499791Shantou Central Hospital, Shantou, China
| | - Guangzhou Du
- Department of Radiology, 499791Shantou Central Hospital, Shantou, China
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Careggi University Hospital, 9300University of Florence, Florence, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Daniel E Furst
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Careggi University Hospital, 9300University of Florence, Florence, Italy.,Division of Rheumatology, Department of Medicine, 8783University of California at Los Angeles, USA.,University of Washington, Seattle, WA, USA
| | - Yukai Wang
- Department of Rheumatology and Immunology, 499791Shantou Central Hospital, Shantou, China.,Department of Experimental and Clinical Medicine, Division of Rheumatology, Careggi University Hospital, 9300University of Florence, Florence, Italy
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Yıldırım F, Yalcin Mutlu M, Erdogan M, Yardimci AH, Bes C. Efficacy of cyclosporine in a patient with lupus mesenteric vasculitis refractory to conventional immunosuppressive therapy. Lupus 2021; 30:1866-1867. [PMID: 34250850 DOI: 10.1177/09612033211031004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Fatih Yıldırım
- Department of Rheumatology, Istanbul Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Melek Yalcin Mutlu
- Department of Rheumatology, Istanbul Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Erdogan
- Department of Rheumatology, Istanbul Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aytul Hande Yardimci
- Department of Radiology, Istanbul Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cemal Bes
- Department of Rheumatology, Istanbul Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
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Hsu D, Khalsa UK, Hassan M, Sandborg CI, Namjoshi SS. Early Intervention and Resolution of Pediatric Intestinal Pseudo-Obstruction in Systemic Lupus Erythematosus: A Pediatric Case Report. JPGN REPORTS 2021; 2:e041. [PMID: 37206925 PMCID: PMC10191485 DOI: 10.1097/pg9.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/04/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Diane Hsu
- From The Division of Gastroenterology, Hepatology and Nutrition, Stanford University, Palo Alto, CA
| | - Uptej K. Khalsa
- The Division of Allergy, Immunology and Rheumatology, Stanford University, Palo Alto, CA
| | - Maheen Hassan
- From The Division of Gastroenterology, Hepatology and Nutrition, Stanford University, Palo Alto, CA
| | - Christy I. Sandborg
- The Division of Allergy, Immunology and Rheumatology, Stanford University, Palo Alto, CA
| | - Shweta S. Namjoshi
- From The Division of Gastroenterology, Hepatology and Nutrition, Stanford University, Palo Alto, CA
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Intestinal Pseudo-Obstruction as the Initial Clinical Presentation in Systemic Lupus Erythematosus: A Rare and Severe Disorder. Case Rep Gastrointest Med 2020; 2020:8873917. [PMID: 33274088 PMCID: PMC7683163 DOI: 10.1155/2020/8873917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/13/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
Intestinal pseudo-obstruction (IPO) is a rarely recognized complication of systemic lupus erythematosus (SLE). We present a 36-year-old African American female, with only known past medical history of anemia, admitted for frequent vomiting, abdominal distension, abdominal pain, diarrhea, and fever that had been ongoing for 5 days. Laboratory results revealed leukopenia and thrombocytopenia. Imaging revealed dilated small bowel loops, abdominal ascites, as well as mild bilateral hydroureteronephrosis without obstructing calculus. Serologic testing confirmed a diagnosis of SLE. The patient was placed on immunosuppressive therapy and responded well. IPO has previously been described as a rare finding in patients with SLE, with bilateral hydroureteronephrosis and lupus interstitial cystitis having been noted as common concomitant factors. One must have a high level of suspicion to recognize it as being one of the initial clinical presentations. Early recognition and appropriate management preclude unnecessary invasive procedures that do not take into account the pathophysiology of the condition and allow for appropriate management and return of peristaltic function.
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York NW, Parker H, Xie Z, Tyus D, Waheed MA, Yan Z, Grange DK, Remedi MS, England SK, Hu H, Nichols CG. Kir6.1- and SUR2-dependent KATP over-activity disrupts intestinal motility in murine models of Cantu Syndrome. JCI Insight 2020; 5:141443. [PMID: 33170808 PMCID: PMC7714409 DOI: 10.1172/jci.insight.141443] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022] Open
Abstract
Cantύ Syndrome (CS), caused by gain-of-function (GOF) mutations in pore-forming (Kir6.1, KCNJ8) and accessory (SUR2, ABCC9) ATP-sensitive potassium (KATP) channel subunit genes, is frequently accompanied by gastrointestinal (GI) dysmotility, and we describe one CS patient who required an implanted intestinal irrigation system for successful stooling. We used gene-modified mice to assess the underlying KATP channel subunits in gut smooth muscle, and to model the consequences of altered KATP channels in CS gut. We show that Kir6.1/SUR2 subunits underlie smooth muscle KATP channels throughout the small intestine and colon. Knock-in mice, carrying human KCNJ8 and ABCC9 CS mutations in the endogenous loci, exhibit reduced intrinsic contractility throughout the intestine, resulting in death when weaned onto solid food in the most severely affected animals. Death is avoided by weaning onto a liquid gel diet, implicating intestinal insufficiency and bowel impaction as the underlying cause, and GI transit is normalized by treatment with the KATP inhibitor glibenclamide. We thus define the molecular basis of intestinal KATP channel activity, the mechanism by which overactivity results in GI insufficiency, and a viable approach to therapy.
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Affiliation(s)
- Nathaniel W York
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, United States of America
| | - Helen Parker
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, United States of America
| | - Zili Xie
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, United States of America
| | - David Tyus
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, United States of America
| | - Maham A Waheed
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, United States of America
| | - Zihan Yan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, United States of America
| | - Dorothy K Grange
- Divison of Clinical Genetics, Washington University School of Medicine, St. Louis, United States of America
| | - Maria S Remedi
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, United States of America
| | - Sarah K England
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, United States of America
| | - Hongzhen Hu
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, United States of America
| | - Colin G Nichols
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, United States of America
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Abstract
INTRODUCTION Intestinal pseudo-obstruction (IPO) is a rare and life-threatening complication of lupus. PATIENT CONCERNS A patient with long-standing lupus developed recurrent abdominal pain and distension as well as nausea and emesis. DIAGNOSIS Imaging showed dilated small bowel loops with air-fluid levels and bowel wall thickening. She also had bilateral hydronephrosis. INTERVENTIONS She was given high-doses of intravenous steroids and cyclophosphamide. OUTCOMES Her symptoms resolved within a week of starting immunosuppression. She was eventually transitioned to mycophenolate mofetil. She remained in remission and immunosuppression was successfully stopped after 1 year. CONCLUSIONS Intestinal pseudo-obstruction is a rare complication of lupus that is often seen in association with ureterohydronephrosis and interstitial cystitis. This clinical syndrome is thought to be because of smooth muscle dysmotility of the gastrointestinal and genitourinary tracts, although the exact mechanism of dysmotility remains unknown. This condition is often responsive to immunosuppression if recognized and treated promptly.
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Maruyama A, Nagashima T, Iwamoto M, Minota S. Clinical characteristics of lupus enteritis in Japanese patients: the large intestine-dominant type has features of intestinal pseudo-obstruction. Lupus 2018; 27:1661-1669. [PMID: 30028259 DOI: 10.1177/0961203318785770] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was performed to investigate the clinical characteristics of lupus enteritis in Japanese patients with systemic lupus erythematosus (SLE). A total of 481 patients with SLE admitted to our hospital between 2001 and 2015 were retrospectively reviewed. Diagnosis of lupus enteritis was based on the following three criteria: (1) abdominal symptoms, (2) diffuse long-segment bowel thickening and (3) a requirement for glucocorticoid therapy. Lupus enteritis was identified in 17 patients (3.5%) and there were two distinct types: small intestine-dominant and large intestine-dominant. Significant differences between the two types were noted with respect to the age, frequency of biopsy-proven lupus nephritis, frequency of rectal involvement, maximum bowel wall thickness, and requirement for steroid pulse therapy. Among patients with large intestine-dominant lupus enteritis, 60% had extra-intestinal symptoms (hydroureter, bladder wall thickening, and bile duct dilatation) that are known complications of intestinal pseudo-obstruction. Two patients with large intestine-dominant lupus enteritis developed intestinal pseudo-obstruction either before or after diagnosis of lupus enteritis. Five patients (29%) developed recurrence during a median observation period of 7.2 years (1.4-14.4 years). In conclusion, large intestine-dominant lupus enteritis resembles intestinal pseudo-obstruction and these two diseases may have a common pathogenesis.
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Affiliation(s)
- A Maruyama
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - T Nagashima
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - M Iwamoto
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - S Minota
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
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Liu Y, Zhu J, Lai JM, Sun XF, Hou J, Zhou ZX, Yuan XY. Reports of three cases with the initial presentation of mesenteric vasculitis in children with system lupus erythematous. Clin Rheumatol 2017; 37:277-283. [DOI: 10.1007/s10067-017-3841-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 12/16/2022]
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Li Z, Xu D, Wang Z, Wang Y, Zhang S, Li M, Zeng X. Gastrointestinal system involvement in systemic lupus erythematosus. Lupus 2017; 26:1127-1138. [PMID: 28523968 DOI: 10.1177/0961203317707825] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem disorder which can affect the gastrointestinal (GI) system. Although GI symptoms can manifest in 50% of patients with SLE, these have barely been reviewed due to difficulty in identifying different causes. This study aims to clarify clinical characteristics, diagnosis and treatment of the four major SLE-related GI system complications: protein-losing enteropathy (PLE), intestinal pseudo-obstruction (IPO), hepatic involvement and pancreatitis. It is a systematic review using MEDLINE and EMBASE databases and the major search terms were SLE, PLE, IPO, hepatitis and pancreatitis. A total of 125 articles were chosen for our study. SLE-related PLE was characterized by edema and hypoalbuminemia, with Technetium 99m labeled human albumin scintigraphy (99mTc HAS) and alpha-1-antitrypsin fecal clearance test commonly used as diagnostic test. The most common site of protein leakage was the small intestine and the least common site was the stomach. More than half of SLE-related IPO patients had ureterohydronephrosis, and sometimes they manifested as interstitial cystitis and hepatobiliary dilatation. Lupus hepatitis and SLE accompanied by autoimmune hepatitis (SLE-AIH overlap) shared similar clinical manifestations but had different autoantibodies and histopathological features, and positive anti-ribosome P antibody highly indicated the diagnosis of lupus hepatitis. Lupus pancreatitis was usually accompanied by high SLE activity with a relatively high mortality rate. Early diagnosis and timely intervention were crucial, and administration of corticosteroids and immunosuppressants was effective for most of the patients.
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Affiliation(s)
- Z Li
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing China
| | - D Xu
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing China
| | - Z Wang
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing China
| | - Y Wang
- 2 Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, China Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - S Zhang
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing China
| | - M Li
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing China
| | - X Zeng
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing China
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Yang C, Chen S, Gaut JP, Dehner LP. Smooth-Muscle Myopathy in Systemic Lupus Erythematosus Presenting With Intestinal Pseudo-Obstruction. Am J Gastroenterol 2016; 111:1501-1502. [PMID: 27694873 DOI: 10.1038/ajg.2016.328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Chen Yang
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St Louis Children's Hospital, Washington University Medical Center, St Louis, Missouri, USA
| | - Simon Chen
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph P Gaut
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St Louis Children's Hospital, Washington University Medical Center, St Louis, Missouri, USA
| | - Louis P Dehner
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St Louis Children's Hospital, Washington University Medical Center, St Louis, Missouri, USA
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Ji C, Yu X, Wang Y, Shi L. Acute lupus pneumonitis followed by intestinal pseudo-obstruction in systemic lupus erythematosus: A case report. Exp Ther Med 2016; 12:245-249. [PMID: 27347044 PMCID: PMC4906679 DOI: 10.3892/etm.2016.3316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/18/2016] [Indexed: 11/07/2022] Open
Abstract
Intestinal pseudo-obstruction (IpsO) and acute lupus pneumonitis (ALP) are uncommon severe complications of systemic lupus erythematosus (SLE). The present study reports the case of a 26-year-old female who presented with abdominal pain, nausea and vomiting as initial symptoms. Computed tomography (CT) scanning revealed the jejunal wall was thickened and streaky, mimicking the presentation of intestinal obstruction. Following emergency surgery, the patient's general condition was aggravated, with evident limb erythematous rashes. A series of laboratory examinations revealed SLE, and combined with patient's medical history IpsO was diagnosed, with a disease Activity Index score of 10. During the therapeutic period, high fever, dyspnea and oxygen saturation (SaO2) reductions were detected, and CT scans indicated lung infiltration, excluding other causes through a comprehensive infectious work-up and a bronchoalveolar lavage examination. ALP was confirmed and treated with high-dose methylprednisolone and gamma globulin supplement. The patient responded well and was discharged in 2 weeks. In the one-year tapering period and after stopping corticosteroids, the patient recovered well with no relapse detected. In conclusion, the manifestation of IpsO in SLE is rare and represents a challenge for the surgeon to establish the correct diagnosis and avoid inappropriate surgical intervention. ALP may be the consequence of emergency surgery, and immediate high-dose glucocorticoid therapy is recommended.
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Affiliation(s)
- Caihong Ji
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xing Yu
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yong Wang
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Lufeng Shi
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Huang Q, Lai W, Yuan C, Shen S, Cui D, Zhao J, Lin J, Ren H, Yang M. Predictors of intestinal pseudo-obstruction in systemic lupus erythematosus complicated by digestive manifestations: data from a Southern China lupus cohort. Lupus 2015; 25:248-54. [PMID: 26405024 DOI: 10.1177/0961203315605366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/12/2015] [Indexed: 01/07/2023]
Abstract
Objective To determine factors that may predict intestinal pseudo-obstruction (IpsO) in systemic lupus erythematosus (SLE) patients complicated by digestive manifestations. Methods SLE patients with digestive manifestations ( n = 135) were followed at Southern Medical University affiliated Nanfang Hospital from 2000 until 2013. Demographic variables, clinical features, and laboratory data were compared between the two groups. Univariate and multivariate logistic regression models were used to establish factors that predispose to IpsO in these patients. Results At the end of the study period, 32 (23.7%) patients had developed IpsO. Mortality (9 patients) was infrequent and the cause of death was unrelated to IpsO. Independent predictors of IpsO in SLE were ureterectasia, anti-U1 RNP+, peritonitis, and low C3 levels. Conclusions Regular abdominal X-ray examinations are recommended in SLE patients with ureterectasia, anti-U1 RNP+, peritonitis, or low C3 levels, as early diagnosis and therapy may prevent unnecessary surgical intervention and improve the disease course.
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Affiliation(s)
- Q Huang
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - W Lai
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - C Yuan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - S Shen
- School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - D Cui
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - J Zhao
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - J Lin
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - H Ren
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - M Yang
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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16
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Jin P, Ji X, Zhi H, Song X, Du H, Zhang K, Shao R, Ge S, Chen Q, Lu H, Lu J. A review of 42 cases of intestinal pseudo-obstruction in patients with systemic lupus erythematosus based on case reports. Hum Immunol 2015; 76:695-700. [DOI: 10.1016/j.humimm.2015.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/09/2015] [Accepted: 09/27/2015] [Indexed: 02/07/2023]
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17
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Oh DJ, Yang JN, Lim YJ, Kang JH, Park JH, Kim MY. Intestinal Pseudo-Obstruction as an Initial Manifestation of Systemic Lupus Erythematosus. Intest Res 2015; 13:282-6. [PMID: 26131004 PMCID: PMC4479744 DOI: 10.5217/ir.2015.13.3.282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/31/2014] [Accepted: 11/20/2014] [Indexed: 01/17/2023] Open
Abstract
Intestinal pseudo-obstruction (IPO) is an uncommon, severe complication that occurs in a small subgroup of patients with systemic lupus erythematosus (SLE). To our knowledge, approximately 30 cases of IPO in SLE have been reported in the literature. Moreover, IPO is rare as an initial manifestation of SLE. We report a case of a 43-year-old woman with SLE who initially presented with IPO.
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Affiliation(s)
- Dong Jun Oh
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jae Nam Yang
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Yun Jeong Lim
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Ji Hyuk Kang
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jung Hyun Park
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Mal Young Kim
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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O'Grady J, Harty L, Mayer N, Critcher V, Ryan J. Immune-mediated necrotizing myopathy, associated with antibodies to signal recognition particle, together with lupus nephritis: case presentation and management. J Clin Med Res 2015; 7:490-4. [PMID: 25883715 PMCID: PMC4394925 DOI: 10.14740/jocmr2133w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 01/29/2023] Open
Abstract
A male patient with limb weakness, myalgia and edema was subsequently found to have an immune-mediated necrotizing myopathy (IMNM) on biopsy. Targeted myopathic antibody analysis revealed antibodies to signal recognition particle (SRP). Anti-SRP-associated necrotizing myopathy was diagnosed. This case was complicated by the concurrent development of class III lupus nephritis. We discuss an interesting case progression and development as well as the management of these difficult to treat conditions.
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Affiliation(s)
- John O'Grady
- Department of Rheumatology, Cork University Hospital, Wilton, Cork City, Cork, Ireland
| | - Len Harty
- Department of Rheumatology, Cork University Hospital, Wilton, Cork City, Cork, Ireland
| | - Nick Mayer
- Cork University Hospital, Wilton, Cork City, Cork, Ireland
| | - Val Critcher
- Cork University Hospital, Wilton, Cork City, Cork, Ireland
| | - John Ryan
- Cork University Hospital, Wilton, Cork City, Cork, Ireland
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19
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Xu N, Zhao J, Liu J, Wu D, Zhao L, Wang Q, Hou Y, Li M, Zhang W, Zeng X, Fang W, Huang X, Zhang X, Tian X, Zhao Y, Zeng X, Zhang F. Clinical analysis of 61 systemic lupus erythematosus patients with intestinal pseudo-obstruction and/or ureterohydronephrosis: a retrospective observational study. Medicine (Baltimore) 2015; 94:e419. [PMID: 25634172 PMCID: PMC4602957 DOI: 10.1097/md.0000000000000419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The objective of this article is to investigate the clinical features of intestinal pseudo-obstruction (IPO) and/or ureterohydronephrosis in systemic lupus erythematosus (SLE). Sixty-one SLE patients with IPO and/or ureterohydronephrosis were analyzed retrospectively. A total of 183 cases were randomly selected as controls from 3840 SLE inpatients without IPO and ureterohydronephrosis during the same period. Patients were assigned to 1 of the 3 groups (SLE with IPO and ureterohydronephrosis, SLE with IPO, and SLE with ureterohydronephrosis). The clinical characteristics, treatments, and prognosis were compared between the 3 groups. There were 57 females and 4 males, with a mean age of 32.0 years. IPO was the initial manifestation of SLE in 49.1% of the cases, whereas ureterohydronephrosis in 32.5%. All patients were initially treated with a high-dose steroid. Thirty-one of these patients (50.8%) also received intravenous methylprednisolone pulse therapy. Two patients died of bowel perforation and lupus encephalopathy, and the other 59 patients (96.7%) achieved remission after treatment. The incidences of fever, glomerulonephritis, nervous system involvement, serositis, erythrocyte sedimentation rate elevation, hypoalbuminemia, hypocomplementemia, and anti-SSA antibody positivity were significantly higher in patients with IPO and/or ureterohydronephrosis than in the control group (without IPO and ureterohydronephrosis). Also, patients with IPO and/or ureterohydronephrosis had higher SLE Disease Activity Index scores than control patients. Compared with SLE patients with IPO, the patients with IPO and ureterohydronephrosis had a significantly higher incidence of gallbladder wall thickening, biliary tract dilatation, and serositis, whereas the patients with ureterohydronephrosis had less mucocutaneous involvement and serositis. Eight of the 47 IPO patients who initially responded well to immunotherapy relapsed; however, all responded well to retreatment with adequate immunotherapy. Of these 8 patients, 4 relapsed following poor compliance and self-discontinuation of steroid or immunosuppressant therapy. The rate of poor compliance with immunotherapy and the number of organ systems involved in patients in the recurrent IPO group were significantly higher than those in the nonrecurrent IPO group. IPO and ureterohydronephrosis are severe complications of SLE. As patients usually respond readily to early optimal steroid treatment, early diagnosis and timely initiation of glucocorticoid are important to relieve symptoms, prevent complications, and improve prognosis.
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Affiliation(s)
- Na Xu
- From the Department of General Internal Medicine (NX, X-JZ, WF, XH); and Department of Rheumatology and Immunology (JZ, JL, DW, LZ, QW, YH, ML, WZ, XZ, XT, YZ, X-FZ, FZ), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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20
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Wang JL, Liu G, Liu T, Wei JP. Intestinal pseudo-obstruction in systemic lupus erythematosus: a case report and review of the literature. Medicine (Baltimore) 2014; 93:e248. [PMID: 25546663 PMCID: PMC4602607 DOI: 10.1097/md.0000000000000248] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Intestinal pseudo-obstruction (IPO) is a rare but dangerous complication of systemic lupus erythematosus (SLE) when the patient has no other manifestations except gastrointestinal symptoms. We performed 1 patient with a 2-month history of recurrent vomiting and abdominal distension. She admitted past surgical histories of cesarean section and appendectomy. A physical examination revealed tenderness in the right lower abdominal on palpation and bowel sounds were weak, 2 to 3 bpm. An x-ray and CT of her abdomen showed intestinal obstruction. The initial diagnosis was adhesive intestinal obstruction. She received surgical treatment because her symptoms had gradually become more frequent and persistent. But she vomited again 2 weeks later after the surgery. Further immunology tests indicated that she had an IPO secondary to SLE. We treated the patient with methylprednisolone pulse for 3 days and followed by prednisone orally. The patient had a good response. Complete remission was achieved on 8 years follow-up. The importance of IPO secondary to SLE lies in an early diagnosis. After the diagnosis is established, immunosuppressive therapy should be the initial and first-line treatment, and surgical intervention is often disappointing and should be carefully avoided. It is necessary to enhance awareness of doctors to IPO secondary to SLE.
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Affiliation(s)
- Jian-Lin Wang
- From the Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
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21
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Yang M, Liang SX, Zhou RH, Mo HY. Clinical characteristics and prognosis of patients with systemic lupus erythematosus with intestinal pseudo-obstruction. Shijie Huaren Xiaohua Zazhi 2013; 21:945-950. [DOI: 10.11569/wcjd.v21.i10.945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the clinical data for patients with systemic lupus erythematosus (SLE) with intestinal pseudo-obstruction (IPO) to improve the understanding of this condition.
METHODS: The clinical data for eight patients with SLE with IPO were retrospectively reviewed to analyze the clinical manifestations, auxiliary examination, therapy and prognosis of this disease.
RESULTS: There were 1 male and 7 females. The average age at the onset of disease was 35 years (range 20-52). The average course from initiation of clinical symptoms to diagnosis was 36 mo. Two patients with intestinal obstruction as the first presentation were misdiagnosed with ulcerative colitis and enteritis, respectively. Six (6/8) cases had renal involvement, 5 (5/8) had hematological system involvement, 5 (5/8) had skin abnormality, and 4 (4/8) had cardiovascular system involvement. Four (4/8) cases had cholecystitis, 4 (4/8) had gastrointestinal bleeding, 4 (4/8) had ascites, and 1 (1/8) had central nervous system involvement. All cases (8/8) were positive for ANA and had hypocomplementemia and higher erythrocyte sedimentation rate. Six (6/8) cases were positive for anti-dsDNA. Glucocorticoid was used for therapy in 6 (6/8) cases and all of them got recovered. There were 2 (2/8) deaths, one for intestinal perforation and the other for surgical intervention.
CONCLUSION: IPO is one of the most serious complications of SLE, which is usually associated with multisystem involvement. People with SLE would encounter with abnormalities in immunologic tests. Early diagnosis and timely use of glucocorticoid are of great importance in controling the disease, improving prognosis, and avoiding inappropriate surgical intervention.
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22
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Kansal A, Jain A, Thenozhi S, Agarwal V. Intestinal pseudo-obstruction associated with biliary tract dilatation in a patient with systemic lupus erythematosus. Lupus 2012; 22:87-91. [PMID: 23104391 DOI: 10.1177/0961203312464091] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intestinal pseudo-obstruction (IpsO) is an uncommon and severe complication of systemic lupus erythematosus (SLE). We report a patient with SLE who presented with IpsO and biliary dilatation (megacholedochus). The co-manifestation of these two conditions in SLE is unusual and has been reported only twice previously. The patient responded well to immunosuppressive treatment. IpsO is a rare but recognized manifestation of SLE that may be the presenting manifestation of the systemic disease or occur more commonly during disease course. Early recognition of IpsO is necessary to institute appropriate medical treatment and to avoid inappropriate surgical intervention.
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Affiliation(s)
- A Kansal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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23
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Ngian GS, Naidoo P, Morand EF, Hoi AY. Smooth muscle myopathy as an underrecognized manifestation of active systemic lupus erythematosus. Intern Med J 2011; 41:495-8. [PMID: 21707895 DOI: 10.1111/j.1445-5994.2011.02505.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with protean manifestations. We here present a case of unexplained diarrhoea and abdominal pain in a patient with SLE. Investigations revealed dilatation of stomach, small bowel and colonic wall, biliary and pancreatic ducts, renal collecting systems and ureters as well as thoracic aorta and major pulmonary arteries, as manifestations of a smooth muscle myopathy that was responsive to immunosuppressive therapy with cyclosporin A.
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Affiliation(s)
- G S Ngian
- Monash Centre of Inflammatory Diseases, Monash Medical Centre, Melbourne, Victoria, Australia.
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24
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Zhang J, Fang M, Wang Y, Mao J, Sun X. Intestinal pseudo-obstruction syndrome in systemic lupus erythematosus. Lupus 2011; 20:1324-8. [PMID: 21680640 DOI: 10.1177/0961203311405702] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Intestinal pseudo-obstruction (IpsO) occurs in a small subgroup of patients with systemic lupus erythematosus (SLE), and has been under-recognized. The etiology and mechanisms are unclear. Herein, we report two cases. In case 1, IpsO occurred as the complication in a previously diagnosed SLE patient. In case 2, IpsO with an image-evidenced intussusception and a peripheral eosinophilia, was the initial presentation, leading to the diagnosis of SLE. In both cases, IpsO existed concomitantly with ureterohydronephrosis, and evolved into peritonitis, which we called together IpsO syndrome. However, this surgical abdomen-like syndrome had a satisfactory response to glucocorticosteroids instead of antibiotics and surgery. Physician awareness and early diagnosis could positively affect outcomes of this syndrome, avoiding unnecessary surgical intervention.
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Affiliation(s)
- J Zhang
- Nephrology Department, First Affiliated Hospital of Dalian Medical University, Dalian, China
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25
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Chng HH, Tan BE, Teh CL, Lian TY. Major gastrointestinal manifestations in lupus patients in Asia: lupus enteritis, intestinal pseudo-obstruction, and protein-losing gastroenteropathy. Lupus 2011; 19:1404-13. [PMID: 20947549 DOI: 10.1177/0961203310374337] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Gastrointestinal (GI) symptoms are common in patients with systemic lupus erythematosus (SLE) and may be due to the disease itself, side-effects of medications, or non-SLE causes. However, GI manifestations of lupus attract far less attention than the other major organ involvements, are infrequently reviewed and rarely documented in published lupus databases or cohort studies including those from countries in Asia. According to three reports from two countries in Asia, the cumulative prevalence of SLE GI manifestations range from 3.8% to 18%. In this review, we focus on three major GI manifestations in patients from Asian countries: lupus enteritis, intestinal pseudo-obstruction, and protein-losing gastroenteropathy, for which early recognition improves outcome and reduces morbidity and mortality.
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Affiliation(s)
- H H Chng
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
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26
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Chen YQ, Xue Q, Wang NS. Visceral muscle dysmotility syndrome in systemic lupus erythematosus: case report and review of the literature. Rheumatol Int 2011; 32:1701-3. [PMID: 21431943 DOI: 10.1007/s00296-011-1856-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Abstract
Intestinal pseudo-obstruction (IPO) is not uncommon in systemic lupus erythematosus (SLE), and IPO in SLE has an apparent association with ureterohydronephrosis. However, hepatobiliary dilatation without mechanical obstruction presenting together with IPO and ureterohydronephrosis is much more scarce in SLE. Here, we named this rare triad of IPO, ureterohydronephrosis, and biliary tract dilatation as visceral muscle dysmotility syndrome (VMDS). It always imitates an acute abdomen and is even life-threatening if treated incorrectly. To diagnose a VMDS, infections and mechanical obstructions should be ruled out carefully. Here, we report a 24-year-old Chinese woman with SLE who presented of VMDS that associated with corticoids tapering induced SLE flare. In this case, early vigorous immunosuppressive treatment conquered the triad timely and thus yielded a good outcome.
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Affiliation(s)
- Yu Qiang Chen
- Department of Nephrology and Rheumatology, Sixth People's Hospital, Shanghai Jiao Tong Unversity, 600 Yishan Road, 200233, Shanghai, China
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27
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Ghannouchi Jaafoura N, Khalifa M, Atig A, Ben Jazia E, Alaoua A, Braham Krifa A, Letaief A, Bahri F. [Chronic intestinal pseudo-obstruction in systemic lupus erythematosus]. Rev Med Interne 2010; 32:e1-3. [PMID: 21035926 DOI: 10.1016/j.revmed.2010.03.458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 02/24/2010] [Accepted: 03/27/2010] [Indexed: 11/27/2022]
Abstract
Intestinal pseudo-obstruction (IPO) is an uncommon and severe complication of systemic lupus erythematosus (SLE). We report a 24-year-old female with a 2 year SLE duration who presented with abdominal pain, vomiting, constipation and abdominal distention. Plain abdominal radiograph showed multiple air-fluid levels of the small bowel. Computed tomographic scan of the abdomen revealed dilated small bowel loops without mechanical obstruction. Urinary tract involvement was also demonstrated. IPO was diagnosed and the patient responded well to immunosuppressive treatment. IPO is a recently recognized manifestation of SLE that may be the presenting manifestation of the systemic disease or occur more commonly during disease course. Early recognition of IPO is necessary to institute appropriate medical treatment and to avoid inappropriate surgical intervention.
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Affiliation(s)
- N Ghannouchi Jaafoura
- Service de médecine interne et des maladies infectieuses, CHU Farhat Hached, Sousse, Tunisia.
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28
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Park FD, Lee JK, Madduri GD, Ghosh P. Generalized megaviscera of lupus: refractory intestinal pseudo-obstruction, ureterohydronephrosis and megacholedochus. World J Gastroenterol 2009; 15:3555-9. [PMID: 19630114 PMCID: PMC2715985 DOI: 10.3748/wjg.15.3555] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Dilated dysfunction involving multiple visceral organs has been reported in patients with systemic lupus erythematosus (SLE). Chronic intestinal pseudo-obstruction (CIPO) resulting from intestinal smooth muscle damage has presented in conjunction with ureterohydronephrosis and, more rarely, biliary dilatation (megacholedochus). While the molecular pathogenesis is largely unknown, observed histopathologic features include widespread myositis, myocyte necrosis in the intestinal muscularis propria with subsequent atrophy and fibrosis, preserved myenteric innervations and little vasculitis. High dose immunosuppression usually results in resolution of symptoms with recovery of smooth muscle function, indicative of an autoimmune etiology. We report a patient with SLE who presented with intestinal pseudo-obstruction, ureterohydronephrosis and megacholedochus, and present images that illustrate megaviscera simultaneously involving all 3 visceral organs. Since the co-manifestation of all 3 is unusual and has been reported only once previously, we have termed this rare clinical syndrome generalized megaviscera of lupus (GML). Although the SLE disease-activity parameters responded to aggressive immunomodulative therapy in our patient, clinical evidence of peristaltic dysfunction persisted in all involved viscera. This is a variation from the favorable outcomes reported previously in SLE patients with GML and we attribute this poor clinical outcome to disease severity and, most importantly, delayed clinical presentation. Since inflammation followed by atrophy and fibrosis are key aspects in the pathogenesis and natural history of GML, the poor response in our patient who presented late in the clinical course may be the result of 'burnt out' inflammation with irreversible end-stage fibrosis. Thus, early recognition and timely initiation of treatment may be the key to recover visceral peristaltic function in patients with GML.
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Affiliation(s)
- Frederick-D Park
- Department of Internal Medicine, Division of Gastroenterology, University of California, San Diego School of Medicine, George Palade Laboratories for Cellular and Molecular Medicine, 9500 Gilman Drive, La Jolla, California 92093-0651, United States
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29
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Intestinal pseudoobstruction associated with eosinophilic enteritis as the initial presentation of systemic lupus erythematosus in children. J Pediatr Gastroenterol Nutr 2009; 48:482-6. [PMID: 19330936 DOI: 10.1097/mpg.0b013e31816b6b7b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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30
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Gastrointestinal symptomatology as first manifestation of systemic erythematous lupus. VOJNOSANIT PREGL 2009; 66:238-41. [DOI: 10.2298/vsp0903238k] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background. Systemic lupus erithematodes (SLE) is chronic, often febrile, multisystemic disease unknown origin and relapsing course which affects connective tissue of the skin, joints, kidney and serous membranes. Gastrointestinal manifestations are rarely the first sign of systemic lupus erythematosus. Case report. We presented a female patient, 35 years old, whose first symptoms of SLE were paralitic ileus (chronic intestinal pseudo-obstruction) and polyserositis (pleural effusion and ascites). Except for high parameters of inflammation, leucopenia and thrombocytopenia, all immunological and laboratory tests for SLE were negative in the onset of the disease. During next six months the patient had clinical signs of paralitic ileus several times and was twice operated with progressive malabsorptive syndrome. The full picture of SLE was manifested seven months later associated with lupus nephritis. Treatment with cyclophosphamide, corticosteroids and total parenteral nutrition (30 days) induced stable remission of the disease. Conclusion. The SLE can be initially manifested with gastroenterological symptoms without any other clinical and immunologic parameters of the disease. If in patients with SLE and gastrointestinal tract involvement malabsorption syndrom is developed, a treatment success depends on both immunosupressive therapy and total parenteral nutrition.
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31
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Johnson CS, Fales-Williams AJ, Reimer SB, Lotsikas PJ, Haynes JS. Fibrosing gastrointestinal leiomyositis as a cause of chronic intestinal pseudo-obstruction in an 8-month-old dog. Vet Pathol 2007; 44:106-9. [PMID: 17197634 DOI: 10.1354/vp.44-1-106] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An 8-month-old, female, mixed-breed dog presented to the Iowa State University Veterinary Teaching Hospital with a 1-month history of vomiting and diarrhea. An exploratory laparotomy was performed revealing markedly distended and fluid-filled small and large intestines that were not obstructed. The clinical condition of the dog did not improve subsequent to exploratory surgery, and it was euthanized. At necropsy, both the small and large intestines were distended (approximately 4 cm in diameter) and fluid-filled, and the wall was thin. The abdominal cavity contained approximately 500 ml of a brownish clear fluid. Microscopic lesions of the intestines were confined to the intestinal tunica muscularis and muscularis mucosae and consisted of locally extensive-to-diffuse replacement of the smooth muscle by fibrous tissue and multifocal infiltration by a moderately dense mononuclear inflammatory infiltrate. A unique finding was the presence of similar microscopic lesions in the tunica muscularis of the urinary bladder and stomach.
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Affiliation(s)
- C S Johnson
- 2764 Veterinary Medicine, Department of Veterinary Pathology, Iowa State University, Ames, Iowa 50011-1250, USA
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32
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Mok CC. Investigations and management of gastrointestinal and hepatic manifestations of systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2005; 19:741-66. [PMID: 16150401 DOI: 10.1016/j.berh.2005.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gastrointestinal (GI) manifestations of systemic lupus erythematosus (SLE) are protean. Any part of the GI tract and the hepatobiliary system can be involved. Up to two-third of SLE patients develop GI symptoms at some stage of their illnesses. Clinical presentations of GI lupus are non-specific and can be difficult to differentiate from infective, thrombotic, therapy-related and non-SLE etiologies. Clinical acumen and appropriate endoscopic, biopsy and imaging procedures are essential for establishing the correct diagnosis. Acute abdominal pain in SLE patients can herald an intra-abdominal catastrophe and should be evaluated promptly. Surgical intervention should be instituted without delay if conservative management fails or when there is clinical or radiological suspicion of visceral perforation or intra-abdominal collections.
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Affiliation(s)
- C C Mok
- Department of Medicine and Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong, China.
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33
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Pardos-Gea J, Ordi-Ros J, Selva A, Perez-Lopez J, Balada E, Vilardell M. Chronic intestinal pseudo-obstruction associated with biliary tract dilatation in a patient with systemic lupus erythematosus. Lupus 2005; 14:328-30. [PMID: 15864921 DOI: 10.1191/0961203304lu2047cr] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the case of a 57-year old female patient diagnosed with systemic lupus erythematosus (SLE) along with glomerulonephritis and chronic intestinal pseudo-obstruction (CIPO). Dilatation of bile and pancreatic ducts not associated with malignant or litiasic obstruction is reported. The combination of bile duct associated with CIPO in a patient with lupus has not been previously reported in the literature and it probably suggests a smooth muscle dysmotility.
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Affiliation(s)
- J Pardos-Gea
- Hospital Vall d'Hebrón, Research Unit in Systemic Autoimmune Diseases, Universitat Autonoma de Barcelona, Barcelona, Spain
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34
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Eastwood JM, McInnes EF, White RN, Elwood CM, Stock G. Caecal impaction and chronic intestinal pseudo-obstruction in a dog. ACTA ACUST UNITED AC 2005; 52:43-4. [PMID: 15703010 DOI: 10.1111/j.1439-0442.2004.00681.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 10-year-old female neutered cross-breed dog presented with a 4-month history of chronic intermittent diarrhoea and vomiting. Abdominal ultrasound showed dilated loops of small intestine and a suspected faecolith. Exploratory surgery revealed a caecal impaction and a typhlectomy was performed. Histopathological examination of caecal and full thickness small intestine sections demonstrated atrophy of smooth muscle fibres as well as an influx of plasma cells, lymphocytes and macrophages, and mild lymphoplasmacytic and eosinophilic enteritis. This combination of caecal impaction and chronic intestinal pseudo-obstruction has not been reported previously in the dog.
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Affiliation(s)
- J M Eastwood
- Davies White Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin, Herts, SG5 3HR, UK
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35
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Alexopoulou A, Andrianakos A, Dourakis SP. Intestinal pseudo-obstruction and ureterohydronephrosis as the presenting manifestations of relapse in a lupus patient. Lupus 2005; 13:954-6. [PMID: 15645752 DOI: 10.1191/0961203304u1064cr] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intestinal pseudo-obstruction (IPO) is a rare complication of systemic lupus erythematosus (SLE). We present a 32-year old female with SLE for seven years. She was admitted with profound fatigue, frequent vomiting, colicky abdominal pain, diarrhoea and intermittent dysuria for the past 12 months. Imaging studies revealed dilated small and large bowel loops with thickened intestinal wall and multiple fluid levels. Urinary tract involvement was also demonstrated. The patient responded well to immunosuppressive treatment. IPO in the context of SLE has been described only in anecdotal case reports. Half of the cases developed this complication during the course of lupus as in the present case. Concomitant ureterohydronephrosis was present in approximately two-thirds of the cases. Early recognition of the syndrome is necessary for the institution of the appropriate medical treatment and prevention of inappropriate surgical intervention.
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Affiliation(s)
- A Alexopoulou
- Academic Department of Medicine, Hippokration General Hospital, Athens, Greece
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36
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Haas S, Bindl L, Fischer HP. Autoimmune enteric leiomyositis: A rare cause of chronic intestinal pseudo-obstruction with specific morphological features. Hum Pathol 2005; 36:576-80. [PMID: 15948126 DOI: 10.1016/j.humpath.2005.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Autoimmune enteric leiomyositis is an extraordinary rare cause of acquired chronic intestinal pseudo-obstruction in children. We report a 5-year-old girl who developed chronic intestinal pseudo-obstruction 3 years after an autoimmune hepatitis. Mucosal biopsies of the upper gastrointestinal tract and colon showed minimal inflammatory changes. On full-thickness biopsies of the small intestine, a dense lymphocytic infiltrate of the muscularis propria was seen, mainly consisting of cytotoxic T lymphocytes. Smooth muscle fibers were degenerated and diminished, but the myenteric plexus was intact. The coexistence of an autoimmune hepatitis in our case indicates an expansion of autoreactive T cells to homologous self-antigens. It is of practical importance for histopathological diagnosis that inflammation in autoimmune enteric leiomyositis affects the muscularis propria of the small intestine, whereas mucosa and submucosa do not show severe inflammatory changes. Therefore, correct diagnosis may be missed in peroral and peranal mucosal biopsies, but full-thickness biopsies are required.
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Affiliation(s)
- Susanne Haas
- Institute of Pathology, Medical Faculty of the University of Bonn, Germany.
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