Gastrointestinal symptomatology as first manifestation of systemic erythematous lupus

Abstract

Background. Systemic lupus erithematodes (SLE) is chronic, often febrile, multisystemic disease unknown origin and relapsing course which affects connective tissue of the skin, joints, kidney and serous membranes. Gastrointestinal manifestations are rarely the first sign of systemic lupus erythematosus. Case report. We presented a female patient, 35 years old, whose first symptoms of SLE were paralitic ileus (chronic intestinal pseudo-obstruction) and polyserositis (pleural effusion and ascites). Except for high parameters of inflammation, leucopenia and thrombocytopenia, all immunological and laboratory tests for SLE were negative in the onset of the disease. During next six months the patient had clinical signs of paralitic ileus several times and was twice operated with progressive malabsorptive syndrome. The full picture of SLE was manifested seven months later associated with lupus nephritis. Treatment with cyclophosphamide, corticosteroids and total parenteral nutrition (30 days) induced stable remission of the disease. Conclusion. The SLE can be initially manifested with gastroenterological symptoms without any other clinical and immunologic parameters of the disease. If in patients with SLE and gastrointestinal tract involvement malabsorption syndrom is developed, a treatment success depends on both immunosupressive therapy and total parenteral nutrition.Uvod. Sistemski eritemski lupus (SLE) hronicno je inflamatorno, cesto febrilno, multisistemsko oboljenje nepoznate etiologije i relapsirajuceg toka, koje zahvata vezivno tkivo koze, zglobova, bubrega i seroznih membrana. Gastrointestinalne manifestacije retko su prvi simptom SLE. Prikaz bolesnika. Prikazana je bolesnica u zivotnoj dobi od 35 godina kod koje se SLE manifestovao klinickim znacima paralitickog ileusa (hronicnom intestinalnom pseudoopstrukcijom) i poliserozitisom (ascites i pleuralni izliv). U pocetku bolesti, pored prisutnih parametara upale, leukopenije i trombocitopenije, laboratorijske i imunoloske analize koje bi ukazivale na SLE bile su negativne. Tokom narednih sest meseci bolesnica je nekoliko puta imala klinicke znake paralitickog ileusa zbog cega je dva puta operisana, a sve izrazeniji bio je malapsorpcioni sindrom. Tek nakon sedam meseci od pocetka bolesti ispoljila se kompletna klinicka slika SLE sa lupus nefritisom. Primena imunosupresivne terapije (ciklofosfamid i kortikosteroidi), uz totalnu parenteralnu ishranu (30 dana), dovela je do klinickog oporavka bolesnice i stabilne remisije bolesti. Zakljucak. Inicijalno, SLE se moze manifestovati gastrointestinalnom simptomatologijom, bez drugih klinicko-laboratorijsko-imunoloskih parametara koji bi ukazivali na ovo oboljenje. Ako se kod SLE sa zahvatanjem gastrointestinalnog trakta razvije sindrom malapsorpcije, na uspeh lecenja, pored imunosupresivne terapije, znacajno utice i primena totalne parenteralne ishrane.