Case reports in gastrointestinal medicine · 2026
Analysis of Diagnosis and Treatment of Active Lupus Enteritis Accompanied by Intestinal Pseudo-Obstruction as the Initial Manifestation: A Case Report and Literature Review.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Zhuang Wenhan, Ji Meijun, Xu Pengfei, Wang Lijuan, Jing Jiyong, Pan Wensheng, Zhang Chenjing
Аннотация
BACKGROUND: Intestinal pseudo-obstruction (IPO) is a rare initial manifestation of systemic lupus erythematosus (SLE), often misdiagnosed as mechanical obstruction or malignant tumor, leading to unnecessary intervention measures and poor prognosis. Case Report: We report a 46-year-old female patient presenting with recurrent abdominal pain and IPO, ultimately diagnosed with SLE through multidisciplinary assessment. The patient exhibited positive antinuclear antibodies (ANAs) (+↑), homogeneous karyotype (+++ 1:1000↑), low complementemia, and lupus nephritis, meeting the diagnostic criteria for SLE. Abdominal CT showed small intestine and colon wall edema with characteristic "target sign" and mesenteric vascular congestion ("comb-like sign"). Initial treatment included pulse therapy with methylprednisolone (240 mg/day) combined with cyclophosphamide and hydroxychloroquine, with symptom relief, but recurrence occurred multiple times during the tapering period.
LITERATURE REVIEW: Analysis of 54 cases of SLE-related IPO (1997-2025) indicated:demographic characteristics: 92.6% were female, and the median age at diagnosis was 31 years. Clinical features: 81.3% of patients presented with abdominal pain; 93.0% involved the small intestine. Imaging examinations: intestinal wall edema ("target sign") and mesenteric vascular hyperplasia ("comb-like sign"); these signs indicate SLE-related small bowel involvement. Immunological examinations: the positive rate of ANAs (ANA) was 75.9%, the positive rate of anti-double-stranded DNA antibody (anti-dsDNA) was 61.1%, and the positive rate of anti-SSA antibody was 42.5%. Prognosis: Despite immunosuppressive treatment, the recurrence rate was 25%; the mortality rate was 7.5%.
CONCLUSION: For patients with recurrent IPO accompanied by low albuminemia, elevated D-dimer, and positive autoantibodies, autoimmune etiology must be considered. Early identification and immunosuppressive treatment are crucial to avoiding unnecessary surgery.
LITERATURE REVIEW: Analysis of 54 cases of SLE-related IPO (1997-2025) indicated:demographic characteristics: 92.6% were female, and the median age at diagnosis was 31 years. Clinical features: 81.3% of patients presented with abdominal pain; 93.0% involved the small intestine. Imaging examinations: intestinal wall edema ("target sign") and mesenteric vascular hyperplasia ("comb-like sign"); these signs indicate SLE-related small bowel involvement. Immunological examinations: the positive rate of ANAs (ANA) was 75.9%, the positive rate of anti-double-stranded DNA antibody (anti-dsDNA) was 61.1%, and the positive rate of anti-SSA antibody was 42.5%. Prognosis: Despite immunosuppressive treatment, the recurrence rate was 25%; the mortality rate was 7.5%.
CONCLUSION: For patients with recurrent IPO accompanied by low albuminemia, elevated D-dimer, and positive autoantibodies, autoimmune etiology must be considered. Early identification and immunosuppressive treatment are crucial to avoiding unnecessary surgery.