case_images: PMC10589013_01
case_images: Patient with a history of systemic lupus erythematosus presenting with abdominal pain. CT of the abdomen and pelvis with iodinated intravenous contrast shows diffuse circumferential wall thickening and edema of the gastric wall (arrow, A), most prominent at the pylorus. There is mild diffuse circumferential wall thickening of the colon prominent at the rectosigmoid region (arrow, B) with peri colonic fat stranding (arrow, C) and small ascites. CT with iodinated IV contrast performed eight months later for abdominal pain again shows similar findings, including diffuse wall thickening and edema involving the stomach (arrow, E), duodenum (arrow, F), and colon (arrowhead, F), including rectosigmoid. Colonic wall thickening with mucosal hyperenhancement, known as the "target sign," is visualized (arrows, D). Diffuse mesenteric edema and engorgement, known as the "comb sign" (highlighted in white, E and arrowhead, G) with small ascites, is noted.
case_images: jchim-13-04-017f1.jpg
case_images: PMC10589013_01_jchim-13-04-017f1.jpg
case_images: f1-jchim-13-04-017
case_images: CT abdomen with contrast demonstrated wall thickening in the distal esophagus, gastric body and antrum (arrows, Fig. 1. Fig. 1. F), proximal bowel loops, colon (arrows, Fig. 1. Fig. 1. F), and rectosigmoid region (arrow, Fig. 1. The classic "target sign," characterized by colonic wall thickening and mucosal hyper enhancement is visualized (arrows,- Fig. 1. Minimal mesenteric vascular engorgement and inflammatory vascular stranding (comb sign) was noted around the proximal bowel loops (highlighted in white, Fig. 1. E and arrowhead, Fig. 1.
case_images: A. This low power image shows several duodenal biopsies from the same patient. It is clear from this magnification that the villous architecture is intact. However, the lamina propria is more cellular than a healthy specimen. 2B. A higher magnification image of the duodenal biopsy reveals neutrophils (blue arrows) within the lamina propria and apoptotic bodies in the glands, indicating active inflammation and glandular injury. There is also an increase in the plasma cells within the lamina propria, indicating chronicity. This pattern of inflammation is consistent with acute chronic enteritis. Though this is nonspecific, autoimmune lupus enteritis is within the differential diagnosis in the appropriate clinical context. (20x).
case_images: jchim-13-04-017f2.jpg
case_images: PMC10589013_01_jchim-13-04-017f2.jpg
case_images: f2-jchim-13-04-017
case_images: An acute on chronic enteritis pattern was noted in the duodenum (Fig. 2.