Lupus enteritis as the only active manifestation of systemic lupus erythematosus: A case report

BACKGROUND Lupus enteritis is a rare manifestation of systemic lupus erythematosus (SLE). Diagnosis of this condition is difficult, especially in the absence of other symptoms related to active SLE. We present the case of a 25-year-old female with lupus enteritis as the sole initial manifestation of active SLE. CASE SUMMARY A 25-year-old African American female presented to the Emergency Department complaining of diffuse abdominal pain, diarrhea, nausea, and vomiting for 2 days. Her past medical history was significant for seasonal allergies and family history was pertinent for discoid lupus in her father and SLE in a cousin. The patient’s vital signs on presentation were normal. Her physical exam was remarkable for significant lower abdominal tenderness without guarding or rigidity. A computed tomography of the abdomen and pelvis revealed marked circumferential wall thickening and edema of the proximal and mid small bowel predominantly involving the submucosa. Our main differential diagnoses were intestinal angioedema and mesenteric vein thrombosis. However, mesenteric vessels were patent, and laboratory testing for hereditary angioedema showed a normal C1 Esterase Inhibitor level and low C3 and C4 levels. Infectious work-up was negative. Autoimmune tests showed elevated anti-nuclear antibodies (ANA)(13.6), anti-Smith antibody, and anti-ribonucleoprotein (anti-RNP) antibody. The patient was diagnosed with SLE enteritis. She was maintained on bowel rest, given intravenous hydration, and started on methylprednisolone 60 mg IV daily. She had significant improvement in her abdominal pain, diarrhea, and emesis after 2 days of treatment. Steroids were tapered and maintained on Hydroxychloroquine with no relapses one year after presentation.CONCLUSION This case of lupus enteritis represents a rare manifestation of SLE. Diagnosis requires clinical suspicion, characteristic imaging and laboratory tests. Endoscopic appearance and biopsies usually yield non-specific findings. High dose steroids are the preferred treatment modality for moderate and severe cases.

Hemodialysis in Pregnant with Systemic Lupus Erythematosus: Case Report and Review

Systemic lupus erythematosus is an autoimmune disease with an etiopathogenesis that is still unclear. With a higher incidence in women of childbearing age. Pregnancy in patients suffering from this pathology is a constant challenge for multidisciplinary teams. The changes of pregnancy, especially to the immune system and the kidney, have repercussions on the renal compromise secondary to lupus. Lupus nephropathy is more active during pregnancy and leads to adverse outcomes for the mother-fetus binomial. The early identification of pregnant women with a higher risk of complications, access to health resources and the participation of a multidisciplinary team is the strategy that increases maternal-fetal survival. A report case of a 25-year-old black female with SLE and a 10-week pregnancy who was admitted to the emergency department with criteria for dialysis. The literature focused on lupus nephritis and dialysis in pregnancy was reviewed. Articles were reviewed in databases such as PubMed, Cochrane, among others, focused on the topic of pregnancy with SLE and pregnancy with dialysis. A total of 15 review articles, 2 meta-analyses, 3 observational studies and 6 cohort studies (3 prospective and 3 retrospective) were filtered.

Association between Premenstrual Dysphoric Disorder and Systemic Lupus Erythematosus: Exacerbation of Major Depression Symptoms?

Introduction: Systemic Lupus Erythematosus (SLE) usually presents neuropsychiatric manifestations, such as psychosis, convulsion, mood disorder and chronic headache, with mood disorder being the most prevalent. It is also known that other psychiatric disorders and menstrual cycle disorders are frequent in SLE. The aim of this study was to describe for the first time the frequency of premenstrual dysphoric disorder in patients with SLE diagnosis, and its association with depression and anxiety. Material and Methods: An evaluation was made of 62 (sixty-two) patients with diagnosis of SLE, based on the American College of Rheumatology criteria, who received follow-up care at an ambulatory reference center. The patients were submitted to a sociodemographic evaluation questionnaire, upon which the Mini International Neuropsychiatric Interview (MINI PLUS), Brazilian Version 5.0.0, was used to evaluate the diagnosis. Results: Twenty (32%) patients were found to have premenstrual dysphoric disorder, and there was a statistically significant association with major depression (p = 0.010), but no statistical significance was found with dysthymia (p = 0.063) or anxiety (p = 0.223). Conclusions: The frequency of premenstrual dysphoric disorder (PMDD) in patients with SLE was high, as well as the frequency of major depression in this group. There was an association between these two disorders.

Chinese Herbal Medicine for Systemic Lupus Erythematosus:A Systematic Review and Meta-Analysis of Randomized,Placebo-Controlled Trials

Objective:To provide evidence on the efficacy and safety of Chinese herbal medicine(CHM)as interventions for systemic lupus erythematosus(SLE).Methods:Seven electronic databases,including the Cochrane Library,Chinese National Knowledge Infrastructure(CNKI),Chinese Scientific Journal Database(VIP),Chinese Biomedical Literature Service System(SinoMed),Wanfang,Embase,and PubMed,were comprehensively searched,from their inception to August 16,2020,for all randomized controlled trials(RCTs)that focused on CHM used alone or in combination with conventional medicine for SLE.Outcomes were SLE activity index(SLEDAI),traditional Chinese medicine symptom/syndrome score(TCMSS),dosage of glucocorticoids,main serological testing,and incidence of adverse events.Data were extracted and pooled using Review Manager 5.3 software.Results:A total of 13 RCTs enrolling 856 participants met our inclusion criteria.Meta-analyses showed that,compared to placebo,CHM had statistically significant effect on reducing SLEDAI score(MD=-1.74,95%Cl:-2.29 to-1.18),diminishing TCMSS(SMD=-0.89,95%Cl:-1.16 to-0.62),decreasing dosage of glucocorticoids(MD=-2.41 mg/d,95%Cl:-3.34 to-1.48),lowering erythrocyte sedimentation rate(MD=-4.78 mm/h,95%Cl:-8.86 to-0.71),and increasing serum complement C4 level(MD=0.03 mg/dL,95%Cl:0.00 to 0.06).No significant difference was found between CHM and placebo on adverse events.Conclusions:CHM provided significant beneficial effect on controlling disease activity and reducing dose of glucocorticoids used among SLE patients.Future advanced designed RCTs for CHM treating moderate to severe SLE with multicenter and longer follow-up are urgently needed.

Telangiectasia-like lesions revealing neonatal lupus erythematosus

To the Editor:A 9-month-old boy presented with red rash over his trunk of one month's duration (Figure1A, 1B). One month earlier, his parents found some red telangiectasias on his prothorax, abdomen and back, which rapidly spread on the skin of his cheek and opisthotic regions (Figure 1C). According to the patient's history, erythematous annular lesions that involved the face and trunk appeared 2 weeks after his birth and were aggravated by sunlight exposure.