Abstract
Purpose: A 33-year-old male presented with 4-day history of postprandial abdominal distention, epigastric pain, and vomiting. Past medical history was significant for systemic lupus erythematosus, diagnosed 6 months prior to presentation. The patient had stopped his immunosuppressive medications as he had been asymptomatic. Admission labs included: WBC count: 13.2 x 10E9/L; CRP: 1.38 mg/dL (0-0.80); ESR: 28 mm/h (0-10); ANA 1:640. Twelve hours after admission, patient's clinical status deteriorated as he developed worsening severe abdominal pain and distention. CT abdomen/pelvis was performed, which showed evidence of small bowel obstruction with marked wall thickening, edema, and dilation of the jejunum. There was a large amount of ascites, abnormal bowel wall enhancement (target sign), and engorgement of mesenteric vessels with increased number of visible vessels (comb sign), consistent with mesenteric vasculitis (see Figure). A diagnostic laparoscopy showed no evidence of impending bowel infarction or necrosis. Based on a clinical diagnosis of lupus mesenteric vasculitis, treatment with highdose pulse intravenous steroids and cyclophosphamide was initiated. The patient's symptoms resolved. This case highlights a rare, poorly understood condition associated with lupus along with pathognomonic CT findings. Because of potential fatal consequences, mesenteric vasculitis should be included in the differential diagnosis for patients with lupus that present with abdominal pain. As in this case, response can be rapid if appropriate therapy is instituted promptly.Figure
Published Version
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