An Atypical Manifestation of SLE

Abstract

Introduction: We describe a rarely reported GI manifestation of SLE: gastroparesis. Case Report: A 51-year-old African American woman with the past medical history of gastroesophageal reflux disease (GERD), idiopathic thrombocytopenic purpura, hypertension, iron deficiency anemia, rheumatoid arthritis, and SLE presented to the ER with 3 days of nausea and vomiting. She was unable to keep any food down. She also complained of abdominal distension, and 9/10 abdominal pain. Bowel habits were normal and she had no fever. She had presented 16 days prior with similar history, along with dehydration and acute kidney injury. During that admission, she also complained of dysphagia prompting a GI referral, esophagogram, and upper GI endoscopy were done which were consistent with moderate-severe GERD. An EGD was performed which showed mild gastroparesis. A provisional diagnosis of viral gastroenteritis was given at that time. During the following admission, a gastric emptying study (GES) was performed demonstrating mild gastroparesis, with more than 66% residual after 2 hours. Her medications did not include any associated with gastroparesis. Surgical causes were ruled out and the patient’s dominant symptoms were thought to be due to the gastroparesis. The duration of the symptoms prompted suggestion of a sub-acute cause, in this case SLE gastroparesis. ReglanTM and ProtonixTM were given to address the patient’s symptomatology. Conclusion: Discussion: Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical obstruction, causing nausea, vomiting, early satiety, bloating, and or upper abdominal pain. The etiology of gastroparesis includes diabetes mellitus, post viral syndrome, medication side effects, postsurgical, neurological, autoimmune, and mesenteric ischemia. Determining the etiology in a patient with SLE is complicated as several of the above mentioned potential etiologies may be present at the same time. Nearly one-third of patients with gastroparesis the cause is idiopathic. In our patient all the usual causes of gastroparesis were ruled out, so it was suggested that she developed this secondary to SLE. Therefore any patient who has SLE with gastrointestinal symptoms, a differential diagnosis should include gastroparesis. SLE as a cause for gastroparesis has been described in literature, but only one case has been reported so far to the best of our knowledge. Current treatment modalities for gastroparesis include dietary modifications such as small meals, prokinetic agents such as metoclopramide and erythromycin, antiemetics, antidepressants, and gastric electrical stimulator implantation in refractory cases.