MARKED GASTROINTESTINAL MANIFESTATIONS IN THE SETTING OF SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract

Systemic lupus erythematosus (SLE) involves multiple organ systems in the body. Manifestations in the gastrointestinal (GI) system are less frequently considered but may contribute to significant morbidity in these patients. This is the case of a 52-year-old female with a long standing history of SLE and chronic corticosteroid therapy who presented with complaints of progressive dysphagia, nausea, vomiting, anorexia, and significant weight loss. Symptoms had been progressing over one year with notable worsening in the weeks prior to her admission. Dysphagia initially only with solids had advanced to difficulty with liquids. Oral consumption dwindled to several tablespoons of water or broth daily. Her weight had dropped from 125 pounds 9 months prior to 75 pounds at time of presentation. Physical examination revealed a cachectic, weak female with hypotension, tachycardia, and axillary adenopathy. Abdominal examination was only remarkable for mild, diffuse tenderness. Laboratory exams revealed dehydration, leukopenia, and serum markers consistent with her diagnosis of SLE (positive antinuclear, anti-double stranded DNA, and anti-Smith antibodies). Amylase, lipase, and liver function tests were all within normal limits. Computed tomography (CT) of the chest, abdomen, and pelvis was notable only for lymphadenopathy in her bilateral axillae and retroperitoneum. Esophagogastroduodenoscopy (EGD) revealed multiple ulcers in the esophagus and duodenum along with gastritis. Biopsies were negative for infection and malignancy. During her 4 week hospitalization, the patient received supportive care, as well as more specific therapy directed by other investigations. Cortico steroids were increased as biopsies of multiple lymph nodes revealed necrotizing lymphadenitis, a rare complication of SLE. Pantoprazole was also initiated given the findings on EGD. In time, the patient's dysphagia improved allowing increased oral intake. GI issues are found in up to 40–50 percent of individuals with SLE. Several possible conditions are dysphagia (the most frequent complaint), abdominal pain, nausea/vomiting, ulcers, mesenteric vasculitis, pancreatitis, hepatomegaly, and elevated liver function tests. Symptoms are often non-specific, but can be attributed to the disease directly or to the medications used in treating the disease. Recognizing the potential disability and morbidity of GI manifestations is important. The realization of GI complications as a manifestation of SLE can lead to more appropriate diagnosis and treatment of these patients.