How to diagnose lupus enteritis early? Lessons learned from a multicenter case series.

Introduction: Lupus enteritis (LE) is a rare, potentially life-threatening manifestation of systemic lupus erythematosus (SLE). Early diagnosis is crucial for early treatment and prevention of serious complications such as ischemic enteritis, bowel infarction with bleeding and/or perforation and peritonitis. The objective of this case review is to identify strategies for early diagnosis of LE. Methods: Retrospective analysis of patients with SLE (fulfilling ACR 1997 and/or SLICC classification criteria) and presenting LE from three tertiary SLE centers was conducted. The diagnosis was based on clinical and imaging features consistent with LE and exclusion of other causes of GI disorders. Results: We report seven cases of LE (female: 100%; age range: 16-55 years). All presented with acute onset abdominal pain, nausea and vomiting at the emergency room. Two patients had lupus enteritis as inaugural manifestation of SLE. Of the remaining five, one presented at the previous visit to the lupus clinic with clinically active disease and two had serologically active/ clinically inactive SLE. High anti-dsDNA antibodies and low serum complement were universally present at time of the LE event. Abdominal ultrasound was the first imaging exam to be performed in the emergency room. In all cases it showed bowel wall thickening, dilatation of intestinal segments, increased reflectivity of mesenteric fat and mild ascites, raising the suspicion of LE and immediate start of treatment. These features were later confirmed by CT scan in five patients. Discussion: Despite being rare, LE must always be considered in any SLE patient presenting with GI symptoms. Abdominal ultrasound can be a reliable first line diagnostic tool for LE.