In December 2011, a 20-year-old adolescent attended the Adolescent Service of the Argerich Hospital due to colic abdominal pain, bloodless stools and fever of 48 hours of evolution.
Personal history: SLE since the age of 6 years, accompanied by diffuse proliferative glomerulonephritis class IV, bizarre, moderate restrictive pulmonary impairment of thrombotic cause, mitral regurgitation, tricuspid hypertension.
Baseline medication at the time of the episode: hydroxychloroquine 400 mg/day; methylprednisone 40 mg/day; methylprednisone 20 mg/day; hypoxic vitamin D2 400 IU/day and calcium citrate every 24 h
Physical features: painful faces, cutaneomucous dryness, asthenia, hyperthermia (38.6oC), tachycardia (126 bpm), tachypnea (28 per minute) and slowed capillary refill.
Abdominal colic pain in the flank and right iliac fossa, which increased with minutes, without visceromegaly.
The patient reported no joint pain.
Thigh blood pressure 120/60 mmHg, weight 65,300 kg, height 1.53 cm. An abdominal x-ray showed the submucosal lesions, and ultrasound showed descending colonpelvic edema.
Contrast-enhanced abdominal CT showed thickening of the left colon wall with mild alteration of fatty tissue, absence of enhancement in the descending colon and few inflammatory changes, consistent with colitis of non-diverticular origin.
An exploratory laparotomy was performed, performing a Hartmann surgery (right colectomy and ileostomy with external fistula) due to ischemic bowel injury.
The anatomopathological diagnosis was severe acute enterocolitis with necrosis and suppuration, without vasculitis or thrombotic microangiopathy.
The patient was hospitalized for 20 days in intensive care, presenting respiratory distress due to severe restrictive ventilatory failure and required mechanical ventilation for one week.
A steroid stress scheme was performed; there were no complications related to the reactivation of the underlying disease during hospitalization.
