A 55-year-old woman diagnosed with SLE for 40 years (renal, nervous and cutaneous affection), APS and supracondylar amputation of both lower limbs due to secondary peripheral vasculopathy.
She was admitted to the emergency room of our hospital with a two-week history of diffuse abdominal pain, nausea, vomiting and anorexia, which had increased in recent days.
He reported decreased intestinal transit, with few diarrheal stools.
He had no fever or other symptoms of SLE activity.
Physical examination revealed a distended and tympanic abdomen, with absence of intestinal sounds and diffuse abdominal pain without clear signs of peritoneal irritation.
Blood tests showed leukopenia (3.0x109/L) and thrombopenia (99x109/L).
Abdominal computed tomography (CT) showed thickening of the wall of the ascending colon and terminal ileum, with moderate amount of free fluid.
With the diagnosis of suspected segmental intestinal ischemia probably related to its APS, she was admitted to the hospital, conservative treatment was established, with intravenous fluids, low molecular weight heparin and therapeutic dose of heparin.
Initially, a surgical exploration was ruled out due to the long duration of symptoms and the lack of clear signs of acute abdomen.
Subsequent laboratory tests showed persistent leucopenia and thrombopenia, decreased complement factors (C3 66 mg/dL, C4 6 mg/dL) and positive anticardiolipin antibodies ANAB, anticardiolipin.
After four days of admission without improvement of symptoms and persistence of dilation of the small intestine in the abdominal radiographs, it was decided to perform a new CT of the free abdomen, which showed thickening and edema of the small mesogurgical halo.
Physical examination had worsened, showing evident signs of acute abdomen.
Considering the clinical profile and laboratory findings, the possibility of a lupus enteritis was suggested and extensively debated, starting with intravenous administration of high doses of corticosteroids.
It was treated with 1 g/d of 6-methyllprednisolone (6-MP) during the first 48 hours and then with 500 mg/d.
Clinical improvement was evident in the first 24 hours, and after three days the patient was asymptomatic, allowing reintroduction of oral diet.
Previous malnutrition status and respiratory infection required specific antibiotic therapy that prolonged hospital stay.
The patient was discharged 29 days later with a maintenance dose of 60 mg/d of prednisone with progressive withdrawal.
