Case Of Chronic Diarrhea Research Articles

Norovirus Causing Chronic Diarrhea in Renal Transplant Recipients

Purpose: The incidence of diarrhea after renal transplant is common, varying from 13-64%, depending on the immunosupressant regime. Post-transplant diarrhea doubles the risk of renal graft loss and mortality. Studies of liver transplant cohorts have suggested that the most common causes of post-transplant diarrhea are Clostridium difficile, cytomegalovirus, and the use of immnosupressive regimes, including mycophenolate mofetil, cyclosporine, tacrolimus, and sirolimus. Recently, norovirus has been implicated as a cause of chronic diarrhea post-renal transplant. Norovirus is the most common cause of acute gastroenteritis worldwide. In immunocompetent individuals, it is self-limiting. A literature review found two case series of patients (n=9 and n=15) demonstrating persistent norovirus infection following renal transplant. Other cases have been documented in immunosupressed patients. In our center, we have identified two cases of chronic diarrhea in renal transplant recipients caused by chronic Norovirus infection. The first was a 65 year-old male with a two-year history of diarrhea following an episode of acute gastroenteritis. Stool frequency was 3-6 bowel movements per day. Stool studies and tests for C. difficile were negative, but tested positive for norovirus. A colonoscopy was normal. Norovirus PCR was performed three times during the course of the diarrhea, and was positive each time, remaining positive for over 16 months. The second patient was a 67-year-old female with an 18-month history of chronic diarrhea following a severe self-limited gastroenteritis. She presented with 5-6 bowel movements a day, and scant blood on a few occasions. Again, colonoscopy and stool studies were normal, as were multiple tests for C. difficile. Norovirus PCR was positive throughout the course of her illness -- in this case for a duration of over 15 months. While diarrhea is common after kidney transplantation, we present two cases of chronic diarrhea post-renal transplant with persistently positive Norovirus PCR. Norovirus may persist in renal transplant recipients or immunocompromised individuals, and should be considered when these patients present with chronic diarrhea.

English

Abstract Introduction Intestinal lymphangiectasia is a protein-losing enteropathy caused by congenital malformation or secondary obstruction of intestinal lymphatic vessels, which usually causes excessive protein loss in the intestine and malabsorption syndrome. Patients may be asymptomatic or complain of oedema, diarrhoea, hypoalbuminaemia and other deficiencies. This article reports a case of chronic diarrhoea and an abdominal mass. Case report We present the case of a 70-year-old woman who came to our gastroenterological clinic for diarrhoea. Blood and stool tests were within the normal ranges, except for a mild eosinophilia and a high C-reactive protein. The ultrasound scan showed a cystic retropancreatic mass, and the following computed tomography scan confirmed the presence of the mass without sure continuity with the dorsal pancreas. The fine needle aspiration performed during an echoendoscopy, permitted the complete aspi ration of the fluid and the cytological analysis that showed numerous lymphocytes. The diagnosis of Intestinal lymphangiectasia was done, and Chronic diarrhoea and abdominal mass: a case of intestinal lymphangiectasia

Su1253 Pediatric Mastocytic Colitis: A New Entity in the Etiology of Chronic Abdominal Pain and Diarrhea in Children

Context: Chronic abdominal pain and diarrhea carry a significant morbidity in the pediatric population and are frequently attributed to irritable bowel syndrome in the absence of inflammatory pathology. Mastocytic colitis is reported in adults but infrequently implicated in the pathology of children and adolescents with chronic abdominal pain or diarrhea. Objective: Describe cases of mastocytic colitis in children with chronic abdominal pain and diarrhea. Methods: We reviewed all cases of chronic diarrhea from 2010 to present from our large urban Pediatric GI practice of biopsy proven colonic mastocytosis (.20 mastocytes/ hpf with tryptase staining in .=5 slices) in the descending colon. Pathology was reexamined and cases with additional findings in the colon or small intestine excluded. The remaining 7 cases were reviewed for symptoms, allergies, diagnostic testing, pathology results, treatments, and additional diagnoses. Results: Age ranged 8-17 years; 6 female, 1 male. All cases except one male with spina bifida experienced abdominal pain (periumbilical, epigastric, right upper quadrant, or diffuse). 5 presented with vomiting, 4 with constipation, and 2 with reflux symptoms. Most had multiple missed school days. Blood work was performed and negative in patients for celiac serologies (4), CRP and ESR (4), thyroid studies (3), amylase and lipase (1), CBC (4) and CMP (4). Stool calprotectin was tested and elevated in one patient. Imaging included abdominal films showing fecal impaction (2). Treatments prior to diagnosis were antacids (5), polyethylene glycol (4), probiotics (1), and antispasmodics (2); 1 received an unknown antibiotic and 1 received albendazole without resolution of symptoms. Due to persistent symptoms, all underwent upper endoscopy and colonoscopy. Of these, 3 had evidence of reflux esophagitis. Biopsies of the small bowel were without pathology and biopsies of the colon showed mastocytosis only. All were started on a mastocyte stabilizer cromolyn; 3 on loratadine, 3 on ranitidine, and 1 on Entocort and rectal hydrocortisone. Additional diagnoses were constipation (4), lactase deficiency (2), GERD (3), NASH (1) and gastroparesis (1). Additional medications post-diagnosis were antacids (3), metoclopramide (1), and hyoscyamine (1). Allergy testing was performed in one and revealed environmental allergies. Of the 7 patients, 2 were diagnosed in sufficient time to exhibit response. Both showed improvement in symptoms with decreased abdominal pain and diarrhea frequency at 1 month with resolution by 22 months in one and improved abdominal pain at 1month in the other. Additional data continues to be collected. Conclusion: Mastocytosis of the colon may contribute to chronic abdominal pain and diarrhea in children and adolescents. This entity should be considered while ruling out additional inflammatory etiologies.

Su1254 Histological Recovery of Proximal Colon Is Incomplete in Patients With Endoscopically Long-Term Quiescent Ulcerative Colitis

Context: Chronic abdominal pain and diarrhea carry a significant morbidity in the pediatric population and are frequently attributed to irritable bowel syndrome in the absence of inflammatory pathology. Mastocytic colitis is reported in adults but infrequently implicated in the pathology of children and adolescents with chronic abdominal pain or diarrhea. Objective: Describe cases of mastocytic colitis in children with chronic abdominal pain and diarrhea. Methods: We reviewed all cases of chronic diarrhea from 2010 to present from our large urban Pediatric GI practice of biopsy proven colonic mastocytosis (.20 mastocytes/ hpf with tryptase staining in .=5 slices) in the descending colon. Pathology was reexamined and cases with additional findings in the colon or small intestine excluded. The remaining 7 cases were reviewed for symptoms, allergies, diagnostic testing, pathology results, treatments, and additional diagnoses. Results: Age ranged 8-17 years; 6 female, 1 male. All cases except one male with spina bifida experienced abdominal pain (periumbilical, epigastric, right upper quadrant, or diffuse). 5 presented with vomiting, 4 with constipation, and 2 with reflux symptoms. Most had multiple missed school days. Blood work was performed and negative in patients for celiac serologies (4), CRP and ESR (4), thyroid studies (3), amylase and lipase (1), CBC (4) and CMP (4). Stool calprotectin was tested and elevated in one patient. Imaging included abdominal films showing fecal impaction (2). Treatments prior to diagnosis were antacids (5), polyethylene glycol (4), probiotics (1), and antispasmodics (2); 1 received an unknown antibiotic and 1 received albendazole without resolution of symptoms. Due to persistent symptoms, all underwent upper endoscopy and colonoscopy. Of these, 3 had evidence of reflux esophagitis. Biopsies of the small bowel were without pathology and biopsies of the colon showed mastocytosis only. All were started on a mastocyte stabilizer cromolyn; 3 on loratadine, 3 on ranitidine, and 1 on Entocort and rectal hydrocortisone. Additional diagnoses were constipation (4), lactase deficiency (2), GERD (3), NASH (1) and gastroparesis (1). Additional medications post-diagnosis were antacids (3), metoclopramide (1), and hyoscyamine (1). Allergy testing was performed in one and revealed environmental allergies. Of the 7 patients, 2 were diagnosed in sufficient time to exhibit response. Both showed improvement in symptoms with decreased abdominal pain and diarrhea frequency at 1 month with resolution by 22 months in one and improved abdominal pain at 1month in the other. Additional data continues to be collected. Conclusion: Mastocytosis of the colon may contribute to chronic abdominal pain and diarrhea in children and adolescents. This entity should be considered while ruling out additional inflammatory etiologies.

Atypical Presentation of Classical Bartter Syndrome as a Case of Chronic Diarrhea and Failure to Thrive

The classical Bartter syndrome is an uncommon tubular disorder of autosomal recessive inheritance, characterized by early childhood onset of polyuria, polydipsia, vomiting, dehydration, constipation and salt craving habit. The long-term outlook for patients with Bartter syndrome is not certain. If not properly treated, it may lead to failure to thrive and growth retardation. We herein report a case of 18-month-old girl child who presented chronic diarrhea and failure to thrive and then was diagnosed as a case of classical Bartter syndrome. She was successfully treated with potassium supplementation and ibuprofen therapy.

Diarrhea and Colonic Ulcers of Unusual Etiology

The present report describes a case of chronic diarrhea with several ulcers in the ascending colon in a 47-yearold woman who immigrated to Canada from the Phillipines. A biopsy from affected colon revealed caseating granulomas and culture grew mycobacterium avium subspecies. Polymerase chain reaction from the colonic biopsy specimen confirmed the presence of mycobacterium avium subspecies that was subsequently identified by hsp65 sequence to be mycobacterium avium hominissuis (MAH). Anti-mycobacterial therapy was started but discontinued by the patient. After 6 months a repeat colonoscopy was macroscopically normal and no granulomas could be seen on biopsies taken from normal appearing colonic tissue. The epidemiological features, host-range and laboratory identification of this unusual organism are discussed.

Collagenous sprue diagnosed by double balloon endoscopy

Double balloon endoscopy (DBE) is useful for diagnosing many intestinal diseases and for endoscopic procedures. We report a case of chronic diarrhea in a 58-year-old Japanese man. He was initially suspected to have malabsorption syndrome. DBE showed reduction of folds, scalloping, mucosal nodularity and granularity. Pathological examinations of biopsies from the jejunum showed severe villous atrophy with subepithelial collagen bands. These findings led to the final diagnosis of collagenous sprue (CS). With1 month of total parenteral nutrition followed by a low-gluten diet, his symptoms gradually improved. CS has never been reported before in Japan. DBE is useful for making a diagnosis of CS, and may be considered for patients who are suffering from diarrhea of unknown cause.

A Case of Chronic Diarrhea Secondary to Capillaria philippinensis in Occidental Mindoro: Possibly a Newly-Described Endemic Area?

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An Enigmatic Case of Chronic Diarrhea, Deciphered

Purpose: A 67-year-old female presents with two years of persistent watery, nonbloody diarrhea. Medical history is significant only for distal esophageal narrowing status post myotomy. Previous workup had included serologic testing for celiac disease, infectious workup, and neuroendocrine markers all which had been normal. Upper endoscopy demonstrated diffuse inflammation of the esophagus with biopsies revealing complete villous atrophy, thickened subepithelial collagen bands with intraepithelial lymphocytosis consistent with collagenous sprue. She was initiated on oral budesonide as well as gluten free and limited lactose diet with significant improvement on discharge. Collagenous sprue is an extremely rare disorder, characterized by diarrhea and severe malabsorption accompanied by histological findings of subepithelial collagen deposition and severe villous atrophy of the small bowel mucosa. Its exact etiology remains under investigation with proposed links to both celiac disease and refractory sprue. Regardless of the etiology, collagenous sprue is thought to represent a poor prognosis with severe morbidity and mortality. Endoscopy may be nonspecific as collagenous sprue, celiac disease, and dyspepsia may show reduction of mucosal folds, scalloping with diffuse granularity. On histopathologic examination, there is presence of a subepithelial collagen band that extends into the lamina propria, however there is no current consensus as to what represents a significant increase in subepithelial collagen with many proposers suggesting thicker than 10-12 μm. Moreover, the degree of mucosal abnormality seen in biopsy does not correlate with severity of clinical symptoms, but rather the overall length of the involved segment appears to be much indicative. The pathophysiology is not completely understood, with thoughts of increased expression of fibrogenic genes, especially procollagen I and increased eosinophils contributing to progression [4]. Treatment includes initiation of a gluten-free diet as well as immunomodulatory therapy. A clinical response was observed in 24 (80%) patients after treatment with combination of a gluten-free diet and immunosuppressants, whereas 9 and 5 patients had histologic improvement and complete remission, respectively.Figure: [877]

Strongyloides stercoralis infestation in HIV seropositive patients in Port Harcourt

Background: A contemporary surge in diarrhoeal illnesses due to parasitic infestations is believed to be a synergy between endemicity and HIV seropositivity. Aim: To determine the prevalence of Strongyloides stercoralis infestation among HIV seropositive patients at the University of Port Harcourt Teaching Hospital. Methodology: A stratified sampling method was adopted, with a working sample size of 524. Inclusion criteria were ART-naive HIV-positive patients presenting for the first time with or without diarrhoea and not on any anti-protozoal regimen. Stool samples were concentrated and examined for larvae by direct wet mount. Results: Of the 524 subjects, 314 (60%) presented with diarrhoea with 104 acute cases and 210 chronic cases. Two hundred and ten (40%) subjects presented without diarrhoea. Enteric parasites were detected in 132 (42%) subjects with diarrhoea and 27 (13%) patients without diarrhoea. Strongyloides stercoralis was only detected in 11 (5.2%) cases of chronic diarrhoea. Conclusion: The synergistic ill-effects of HIV and parasitic co-infection underscores the need for prompt identification and effective therapy. Keywords: Strongyloides stercoralis, Strongyloidiasis, Diarrhoea, HIV, Port Harcourt.

Eosinophilic Gastroenteritis: A Rare Case Report

Eosinophilic gastroenteritis (EGE) is a rare disease characterized by eosinophilic infiltration and peripheral eosinophilia. It can be seen anywhere in the gastrointestinal tract. It is diagnosed in the biopsies taken during endoscopic examination to the patients with abdominal pain and chronic diarrhea. A 40-year-old woman was admitted with abdominal pain and chronic diarrhea. She has not any disease, food, pollen, or drug allergy in her medical history. Leukocyte: 19,400/mm3 (neutrophil: 19.9%, eosinophil: 57.4%, lymphocyte: 16.5%), platelet: 281,000/ mm3, immunoglobulin E: 1721 IU/mL (normal range: 20–100 IU/mL) was counted in her blood examination. The duodenal biopsy was reported as EGE. We applied methylprednisolone 20 mg/day. With this treatment, the patient's symptoms regressed. In this article we present a case of chronic diarrhea diagnosed EGE. The first step in diagnosing is suspecting EGE. It should be borne in mind in patients with chronic diarrhea.

Utilizing environmental, socioeconomic data and GIS techniques to estimate the risk for ascariasis and trichuriasis in Minas Gerais, Brazil

The impact of intestinal helminths on human health is well known among the population and health authorities because of their wide geographic distribution and the serious problems they cause. Geohelminths are highly prevalent and have a big impact on public health, mainly in underdeveloped and developing countries. Geohelminths are responsible for the high levels of debility found in the younger population and are often related to cases of chronic diarrhea and malnutrition, which put the physical and intellectual development of children at risk. These geohelminths have not been sufficiently studied. One obstacle in implementing a control program is the lack of knowledge of the prevalence and geographical distribution. Geographical information systems (GIS) and remote sensing (RS) have been utilized to improve understanding of infectious disease distribution and climatic patterns. In this study, GIS and RS technologies, as well as meteorological, social, and environmental variables were utilized for the modeling and prediction of ascariasis and trichuriasis. The GIS and RS technologies specifically used were those produced by orbital sensing including the Moderate Resolution Imaging Spectroradiometer (MODIS) and the Shuttle Radar Topography Mission (SRTM). The results of this study demonstrated important factors related to the transmission of ascariasis and trichuriasis and confirmed the key association between environmental variables and the poverty index, which enabled us to identify priority areas for intervention planning in the state of Minas Gerais in Brazil.

Mastocytic enterocolitis as a rare cause of chronic diarrhea in a patient with rheumatoid arthritis

The prevalence of chronic diarrhea within the U.S. population has been reported to be as high as five per cent, and numerous causes have been identified. Especially in patients suffering from rheumatoid arthritis drug therapy should be considered as possible cause. We report a case of chronic diarrhea triggered by mastocytic enterocolitis in a patient suffering from rheumatoid arthritis. Systemic mastocytosis and other causes of chronic diarrhea, especially therapy with methotrexate, were carefully ruled out. Treatment with desloratadin and ranitidine was initiated and led to a rapid and persistent amelioration of clinical symptoms. The diagnosis of mastocytic enterocolitis should be considered in patients with chronic diarrhea and normal clinical, laboratory, as well as endoscopical work-up.

Acute Diarrheas among French Soldiers in Djibouti

Dear Sir: I read with great interest the article published by Ollivier and others1 about gastrointestinal illnesses among French Forces deployed to Djibouti. It offers a panorama of infectious diarrheas occurring in French soldiers deployed in this East African country and points out the high incidence rate of these affections even compared with Western Africa. I worked in the Medicine Unit of the French military hospital in Djibouti between 2005 and 2007. Infectious diarrheas is a sanitary problem among military communities, especially in Djibouti, as stated in this article.1 I also agree with their results on the annual repartition of cases. In our unit, we observed an increased rate of acute diarrheas after the end of September, which corresponds to the beginning of the cool season and the reemergence of many flies, which have disappeared before because of the high temperatures during previous months. The first weeks of the stay in Djibouti are also marked for the huge majority of people by transient stools modifications and upper respiratory tract infections thought to correspond to new bacterial and viral environment adaptation. However, this work avoids speaking about minor salmonellosis and especially giardiasis, which constitute locally two main etiologies of acute, subacute, and chronic diarrheas in my Djiboutian experience. Giardiasis was a cause of acute non-febrile diarrhea with a trend to chronic evolution and its association with amebiasis, salmonellosis and shigellosis was not uncommon. Giardiasis diagnosis was not easy in Djibouti because only stool smear direct examination was disponible in our laboratory. Duodenal biopsies realized during upper digestive tract endoscopy were sent to France for histological and parasitological examinations in some cases of chronic diarrhea. Therefore, this parasitological diarrhea might be frequently missed. In clinical practice, at the beginning, we used to prescribe metronidazole presumptively as a second-line therapy after first-line treatment failure and later, we associated metronidazole to fluoroquinolone as first-line treatment of each case of acute diarrhea even if initially febrile. Metronidazole was also used as systematic first-line therapy of each case of chronic diarrhea. Therefore, it would be of great interest to add giardiasis in French soldiers' health surveillance because it is not rare in Djibouti. It can also chronicize or induce chronic intestinal functional disorders,2 which could invalidate soldiers during their mission, especially when of short duration.

CHRONIC DIARRHEA IN AN ELDERLY MAN

CHRONIC DIARRHEA IN AN ELDERLY MAN

Chronic Diarrhea and Pancolitis Caused by Paracoccidioidomycosis: A Case Report

South American blastomycosis is a systemic micosis caused by infection with Paracoccidioides brasiliensis. The most frequently affected sites are the lower lip buccal mucous membrane, palate, tongue, sublingual region, lymph glands, and lungs. However, colonic involvement is not a common expression of Paracoccidioidomycosis. We report a case of chronic diarrhea and pancolitis caused by Paracoccidioidomycosis with fatal outcome.

A Case of Chronic Diarrhea and Colonic Stricture Mimicking Crohnʼs Disease

A Case of Chronic Diarrhea and Colonic Stricture Mimicking Crohnʼs Disease

A Rare Case of Chronic Diarrhea in an Elderly Male

SUMMARY Chronic diarrhea is a common condition in older age groups, and many patients do not seek medical attention unless their diarrhea is associated with other symptoms, such as weight loss, gastrointestinal bleeding or abdominal pain. It is a critical condition in the elderly, especially with systemic disease. We report the case of an elderly patient with chronic diarrhea secondary to intestinal capillariasis. Human intestinal capillariasis is a rare parasitosis of the gastrointestinal tract, which may be a fatal disease if early treatment is not given. The clinical hallmarks of capillariasis include chronic diarrhea, abdominal pain, borborygmi, marked weight loss, protein and electrolyte loss, and cachexia. Most patients die from electrolyte loss resulting in heart failure and/or septicemia. Taiwan, particularly in Taitung County, is a Capillaria-prevalent area. Thus, parasitosis must be considered in the differential diagnosis of patients with debilitating chronic diarrhea, especially in the elderly aboriginal population of Taitung County. A careful dietary and travel history is important in any such case; but even in the absence of clear-cut exposure, a parasitic infection should be considered and carefully investigated. (International Journal of Gerontology 2009; 3(2): 122-125)

Chronic diarrhea and melanosis coli caused by wellness drink

Dear Editor: The development of melanosis coli due to anthraquinonecontaining laxatives is well established. Melanosis coli is an unspecific pigmentation of the colonic mucosa that can sometimes be detected by endoscopy, but is more often revealed by histology only. The pigmentation is caused by apoptotic cells which are ingested by macrophages and subsequently transported into the lamina propria, where lysosomes use them to produce lipofuscin pigment, not melanin as the name suggests. Some authors therefore prefer the expression “pseudomelanosis coli”. It is mostly reversible after withdrawal of the anthraquinone. Although there is no convincing evidence for chronic use of anthraquinone-containing laxatives to be a risk factor for colorectal neoplasia or colonic nerval degeneration in humans, severe adverse effects have been reported for these drugs. Here, we report a case of chronic diarrhea in which the histopathologic finding of melanosis coli lead to anthraquinones which were consumed as general wellness medication. A 76-year-old male patient of Russian origin was referred to our hospital with chronic diarrhea of 6 months duration. He reported six to eight watery bowels per day which also occurred at night. Further symptoms were abdominal pain before defecation and meteorism. He denied weight loss, fever, night sweats, or vomiting. Preexisting medical conditions included a Billroth II operation for duodenal ulcer disease, arterial hypertension, cataract, and ischemic stroke with minor residua. At the time of admission, the patient was regularly taking aspirin and metoprolole. Lactose intolerance had been diagnosed earlier but diarrhea continued under a lactose-free diet. He had been a smoker of 50 pack years until 5 years prior. On admission, he was afebrile with a heart rate of 74 and blood pressure of 165/85. Physical examination was unremarkable, the abdomen showed no tenderness or other pathological findings. Laboratory data for sodium, potassium, CRP, white blood cell count, pancreasand liverenzymes were normal. Minimal anemia was present (hemoglobin 13.4 g/dl, normal 14–18). Apart from reduced vitamin B12 (152 ng/l, normal 310–1,100) laboratory values did not indicate malabsorption: iron, calcium, vitamin D, and folic acid were normal. Stool specimens for bacterial and parasitic agents where unremarkable. Abdominal ultrasound showed no abnormal findings apart from mild hepatic steatosis. Duodenal biopsy did not yield evidence of Whipple’s or celiac disease. A colonoscopy was performed, showing diverticulosis, two erosions in the Int J Colorectal Dis (2009) 24:595–596 DOI 10.1007/s00384-008-0625-7

Chronic Diarrhea

Purpose: Gastrointestinal (GI) involvement in SLE is not uncommon. However, SLE is often overlooked in the differential diagnosis of patients who present with certain GI symptoms. We describe a case of chronic diarrhea as the predominant presenting feature of SLE. Methods: N/A Results: A 63 year-old African American lady was admitted repeatedly to the hospital with nausea, vomiting and diarrhea over 5 months. She had no arhralgias or swelling. The patient appeared cachectic with satisfactory vitals, conjuncivae were pale, and FOBT was (+). Labs showed a hemoglobin 8 g/dl, BUN 40 mg/dl, creatinine 3.1 mg/dl, magnesium 1.3 mg/dl and potassium 2.7 mmol/l. Urine analysis showed hematuria, pyuria and nephrotic range proteinuria. Further investigations revealed iron, folate and vitamin D deficiency. Stools had no pathogens or parasites. Poor tolerance of a 100 g/day fat diet precluded 72-hour fecal fat test. Kidney ultrasound disclosed hydronephrosis without stones. An upper endoscopy and colonoscopy demonstrated ulcerative esophagitis with esophageal and gastric stasis. Small bowel and colon biopsies were unremarkable including a Congo red stain. Her hydronephrosis and obstructive uropathy required bilateral ureteral stent placement and an indwelling Foley catheter. Her diarrhea was treated with cholestyramine and electrolyte replacement without success. Because of the multi-organ involvement, further investigations for paraproteinemia and autoimmune disease were undertaken. Serologic studies revealed a positive ANA and a positive anti-dsDNA and anti-Smith antibodies. Her anemia, proteinuria and the positive antibodies were all consistent with the diagnosis of systemic lupus erythematosus. Therapy with corticosteroids was started, with an excellent response; the diarrhea subsided within 48 hours, and the patient regained weight and strength. Conclusion: Gastrointestinal symptoms account for 25–40% of the presenting clinical manifestations of SLE. It can affect the entire GI tract. However, GI symptoms as the sole presentation of SLE are a rare phenomenon. Chronic diarrhea in SLE can be secondary to colitis, celiac disease, protein losing enteropathy, or malabsorption. Interestingly, the random gastrointestinal biopsies in our patient did not show any significant pathological abnormalities. We hypothesize that our patient may have had either patchy small bowel disease or possibly malabsorbtion from dysmotility. Moreover, there are a few reports in the literature on the association of obstructive uropathy and intestinal malabsorption in SLE patients. This case highlights chronic diarrhea with obstructive uropathy as a possible, albeit unusual, presentation of SLE.