Background and aims Gastrointestinal (GI) involvement in SLE ranges from 2.2%–9.7%, and nonspecific manifestations pose a diagnostic challenge. This series describes characteristics, treatment and outcomes of patients with GI involvement as the primary manifestation of SLE activity.
Methods Case series of 10 Filipino SLE patients with proven GI flares, seen at the Lupus Clinics of University of Santo Tomas (UST) Hospital, Manila, Philippines.
Results All 10 patients were females with mean age 31.7+9.35 SD (19 - 49) and disease duration 6.08±7.34 SD (0 - 22) years. Most commonGI manifestations were abdominal pain (100%), ileus (60%), vomiting (50%) and diarrhoea(40%). Extra-intestinal manifestations included malar rash (70%), arthritis (60%), hypocomplementemia (60%), alopecia (50%), and hemolyticanemia (40%). All patients showed significant initial response to high dose corticosteroid. Three patients eventually required surgery including ileal resection, abdomino-perineal resection and appendectomy; post-op histopath findings confirmed vasculitis in all 3 patients. One patient with ileal ischemia and perforation requiring resection also received belimumab infusions which enabled successful tapering and discontinuation of steroid. Another patient with refractory protein losing enteropathy and ischaemic colitis underwent abdomino-perineal with ileal resection, but succumbed to anastomotic failure with fulminant bacterial peritonitis.
Conclusions Though rare, gastrointestinal flare in SLE can be potentially catastrophic. Because of nonspecific manifestations, diagnosis strongly relies on clinical assumption and response to steroids. In some cases, surgery can be life-saving and belimumab offers another effective therapeutic option.
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