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229 Mycophenolate mofetil for induction of remission in lupus enteritis
  1. N Nasir,
  2. A Syed and
  3. MM Riaz
  1. Aga Khan University, Section of Internal Medicine- Department of Medicine, Karachi, Pakistan

Abstract

Background and aims Lupus enteritis (LE) is a distinct gastrointestinal manifestation of systemic lupus erythematosus, and is a major cause of acute abdominal pain in these patients. Once recognised, management of this condition consists of immunosuppressive therapy with corticosteroids and other medications which includes cyclophosphamide, azathioprine and mycophenolate mofetil. Mycophenolate mofetil (MMF) is an immunosuppressive agent that inhibits both B and T lymphocyte proliferation. MMF reduces antibody production, and can affect glycosylation of adhesion molecules, and their in vitro expression.The aim of study was to determine the efficacy of Mycophenolate mofetil in the induction of remission in patients with lupus enteritis.

Methods We describe a case series of five patients with lupus enteritis. Laboratory features included low complement levels , anaemia, leukocytopenia or leukocytosis and thrombocytopenia .Median CRP level was 2.0 mg/dL (range 0–8.2 mg/dL) Acute kidney injury was present in 60% of the cases. Ct abdomen revealed bowel wall oedema (95%), ascites (92%), the characteristic ”target sign” (98%), mesenteric abnormalities (88%) and bowel dilatation (96%). All patients received induction with high dose pulse methylprednisone 1000 mg IV for three days followed by prednisone at a dose of 1 mg/kg/day. Subsequently, Mycophenolate mofetil 1000 mg twice a day was added in the regimen for remission. Only 1 patient developed ileocecal preforation but survived the condition after undergoing laparotomy and ileostomy. Relapses were uncommon ( 25%) and managed with optimisation of immunosuppressive regimen.

Conclusions Mycophenolate mofetil (MMF) appears promising as an agent of remission induction and maintenance in patients with lupus enteritis.

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