Clinical significance of D-dimer in early diagnosis of mesenteric vasculitis in systemic lupus erythematosus / 医学研究生学报

ObjectiveLupus mesenteric vasculitis (LMV) can lead to extensive necrosis of the small intestine, and it is easy to be misdiagnosed and missed in the early stage of the disease. This study aims to evaluate the clinical significance of serum D-dimer level in the early diagnosis of LMV.MethodsRetrospective analysis was performed on 38 patients with systemic lupus erythematosus (SLE) admitted to Nanjing Drum Tower Hospital from January 2006 to January 2019. There were 15 LMV patients (LMV Group) and 23 non-LMV patients (Non-LMV Group). The main observation indicators of statistical analysis were serum D-dimer level on the first day of treatment in the two groups, while the secondary indicators included patient general condition, SLE disease activity index (SLEDAI), enhanced CT examination results, laboratory examination results and serum D-dimer level after treatment.ResultsThere was no significant difference in age, SLE duration and SLEDAI between the two groups (P>0.05). On admission, CT showed LMV patients with intestinal dilatation, mesenteric edema and typical target symptoms. After high-dose hormone therapy, the dilatation of intestinal canal and intestinal wall were significantly relieved, and the target signs on CT disappeared before discharge. The serum D-dimer level of patients in the LMV Group [917 (756,1848) μg/L] was significantly higher than that in the Non-LMV Group [570 (356,896) μg/L], and the difference was statistically significant (P=0.006). ROC curve analysis showed that the critical value of serum D-dimer in early diagnosis of LMV was 624 μg/L, and the sensitivity and specificity were 93% and 61%, respectively (AUC=0.77).ConclusionSerum D- dimer level can be used as an effective index for early diagnosis of LMV patients.

Clinical significance of D-dimer in early diagnosis of mesenteric vasculitis in systemic lupus erythematosus / 医学研究生学报

ObjectiveLupus mesenteric vasculitis (LMV) can lead to extensive necrosis of the small intestine, and it is easy to be misdiagnosed and missed in the early stage of the disease. This study aims to evaluate the clinical significance of serum D-dimer level in the early diagnosis of LMV.MethodsRetrospective analysis was performed on 38 patients with systemic lupus erythematosus (SLE) admitted to Nanjing Drum Tower Hospital from January 2006 to January 2019. There were 15 LMV patients (LMV Group) and 23 non-LMV patients (Non-LMV Group). The main observation indicators of statistical analysis were serum D-dimer level on the first day of treatment in the two groups, while the secondary indicators included patient general condition, SLE disease activity index (SLEDAI), enhanced CT examination results, laboratory examination results and serum D-dimer level after treatment.ResultsThere was no significant difference in age, SLE duration and SLEDAI between the two groups (P>0.05). On admission, CT showed LMV patients with intestinal dilatation, mesenteric edema and typical target symptoms. After high-dose hormone therapy, the dilatation of intestinal canal and intestinal wall were significantly relieved, and the target signs on CT disappeared before discharge. The serum D-dimer level of patients in the LMV Group [917 (756,1848) μg/L] was significantly higher than that in the Non-LMV Group [570 (356,896) μg/L], and the difference was statistically significant (P=0.006). ROC curve analysis showed that the critical value of serum D-dimer in early diagnosis of LMV was 624 μg/L, and the sensitivity and specificity were 93% and 61%, respectively (AUC=0.77).ConclusionSerum D- dimer level can be used as an effective index for early diagnosis of LMV patients.

A clinical analysis of 36 cases of systemic lupus erythematosus with lupus mesenteric vasculitis / 中华风湿病学杂志

Objective To analyze the clinical profiles of lupus mesenteric vasculitis (LMV).Methods Thirty-six SLE patients diagnosed with LMV and 72 SLE patients (1:2) without LMV at West China Hospital between October 2009 and January 2012 were enrolled.The imaging,clinical manifestation,laboratory examinations data were analyzed retrospectively.Quantitative differences were analyzed by the Student's t and Z tests and qualitative data were compared with Chi-square.P value less than 0.05 was considered as statistically significant.Results ① The prevalence of LMV in patients with SLE was 1.2％(36/3 051),while 47％(17/36) as the initial symptom of SLE.Thirty-six LMV patients were all female.The prevalence of abdominal pain was 78％(28/36),nausea or vomitting was 58％(21/36),abdominal distension was 50％(18/36),diarrhea was 47.2％ (17/36),intestinal perforation was 3％ (1/36) and incomplete obstruction was 8％ (3/36).Enhanced CT scan showed 81％(25/31) patients suffered from intestinal dilation and (or) mesenteric edema;SLEDAI (17±5),C3 (0.44±0.25) g/L,C4 (0.10±0.09) g/L,Z value on above items were 4.30,-3.85 and-2.94 respectively compared to SLE patients without LMV,and all P＜0.05,the differemces were significant.In addition,Also,the proportion of ANA and anti-ENA antibody showed no significant difference.68.6％(13/36) patients were also diagnosed with lupus nephritis;61％(22/36) patients were treated with methylprednisolone more than 200 mg/d resulting in relief of symptom.Conclusion Female patients with SLE may be more likely to suffer from LMV;Enhanced abdominal CT scan is still essential to the diagnosis of LMV.LMV is correlated with urinary system malfunction.LMV always occurs in active lupus with low C3 and C4 level.More than half patients should be treated with corticosteroid and cyclophosphamide pulse therapy.

Localized Mesenteric Vasculitis in a Patient with Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is an uncommon disorder characterized by bilateral pain and stiffness in the shoulder and pelvic girdles. Polymyalgia rheumatica and giant cell arteritis (GCA) occur in the same patient population and share a common pathogenesis. Giant cell arteritis predominantly affects the cranial arteries and rarely involves the gastrointestinal tract. Moreover, giant cell arteritis has rarely been reported in Asians. Here, we present a case with 62-year-old Asian woman who developed polymyalgia rheumatica with localized vasculitis in the mesenteric arteries.

A Case of Systemic Lupus Erythematosus Manifesting First as Mesenteric Vasculitis

Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease that manifests various symptoms. Mesenteric vasculitis (MV) is one of the serious complications of SLE and carries a high mortality rate. Although MV is the main cause for acute abdominal pain in patients with SLE, it is very rare for the pain to be the first clinical manifestation of the disease. A 34-year old female presented with sudden onset abdominal pain accompanied by small intestinal bowel edema observed on abdominal computed tomography. We performed a diagnostic laparoscopy, as vital signs were becoming unstable and the diffuse abdominal tenderness was worsening rapidly. The examination showed a severe jejunal infarction; thus, the patient underwent a small bowel segmental resection. A histological examination revealed multiple, hemorrhagic, small-vessel vasculitis, and later serologic autoimmune markers were consistent with SLE. We suggest that SLE be considered in the differential diagnosis of young females presenting with an acute abdomen and unexplained enteropathy. A surgical approach such as exploratory laparoscopy could be an option in search for the cause.

A clinical analysis 30 cases of lupus mesenteric vasculitis / 中华内科杂志

Objective To characterize the clinical characteristics of lupus mesenteric vasculitis (LMV). Methods Analyzing the clinical, laboratory and treatment data of LMV patients hospitalized from 2002. 1.1 to 2007. 12. 31 retrospectively. Results (1) The three common manifestations were abdominal pain, diarrhea and vomit with the prevalence rate of 77%, 70% and 67% respectively. (2)The majority of LMV cases were active vital organ (28/30), kidney (24/30) and hematological system (18/30) were the main organs of involvement. Ten patients had hydroureteronephrosis, and 8 patients had intestinal pseudo-obstruction at the same time. (3) Systemic lupus erythematosus disease activity index (SLEDAI) score was ≥10 in 80% (24/30) of patients. The progression of LMV was accompanied with new-onset ieucopenia or worsening leucopenia or hypocomplementemia in 10 cases. (4) Blood antinuclear antibodies were positive in 27 patients detected, and anti-SSA antibody was positive in 15 (56%), anti-U1RNP antibody was positive in 14 (52%). (5) Fourteen cases had bowel wall thickening with target sign or mesenteric vessels with palisade or comb sign in contrast CT scan of abdomen. (6)Twenty-seven cases were treated with orally or intravenous medium to high dose steroid therapy and recovered from LMV. Conclusions (1) Abdominal pain, diarrhea and vomit were frequent manifestations of LMV patients. (2) LMV was one of the serious complications of systemic lupus erythematosus(SLE), and usually accompanied by active SLE in other organs. (3) A drop in the white blood cell count or complement C3 titer might be correlate with the occurrence of LMV. It needs to further investigate the relationship between LMV and the high positive rate of anti-SSA and anti-U1RNP antibody. (4) LMV patients responded well to intravenous high dose methylprednisolone.

Three Cases of Lupus enteritis: Response to Steroid Therapy / 대한류마티스학회지

Systemic lupus erythematosus is a systemic disorder which has frequent involvement of gastrointestinal tract. Non specific symptoms such as anorexia, nausea, diarrhea and abdominal pain are well known symptoms when the gastrointestinal tract is involved. The most feared gastrointestinal complication of systemic lupus erythematosus is lupus enteritis. The pathological change in lupus enteritis is usually a result of mesenteric vasculitis. Major complications such as intestinal bleeding and perforation may occur and sometimes result in sugery. Because of high mortality rate in case of major complications, early diagnosis and appropriate treatment is very important. We experienced three patients with lupus enteritis who presented with severe abdominal pain and dirrhea. They were diagnosed by characteristic radiographical findings of small bowel series and barium study. All radiographical findings has been resolved completely with the steroid therapy. Conclusively we can induce complete remission by steroid therapy alone, if we diagnose lupus enteritis in the early period of disease course.

A Case of Lupus Mesenteric Vasculitis Resulting in Small Bowel Infarction / 대한류마티스학회지

Systemic lupus erythematosus(SLE) is an autoimmune disease involving many organs. Mesenteric vasculitis is one of the serious organ involvement in this disease. Mesenteric vasculitis may produce mucosal ulceration, bowel edema with paralytic ileus, hemorrhagic ileitis, intussusception, perforation and mesenteric infarction. Because of high mortality rate, early diagnosis and treatment of this manifestation is very important. We experienced a case of SLE with extensive smell bowel infarction due to mesenteric vasculitis. She was 29 years old. She was suffered frem severe abdominal pain for three days. Abdominal computed tomography showed diffusse wall thickening of the small intestinal wall. After high dose intravenous steroid, her abdominal symptoms were improved. She was discharged with low dose oral steroid(15mg/day) treatment. Seven months later, she presented with sudden abdominal pain. Intravenous methylprednisolon(2mg/Kg) was started. Three days later, her abdominal symptoms were not subsided. On the plain radiograph of the abdomen, marked ileus was demonstrated. Mesenteric angiography showed diffuse decreased small bowel vascularity. A provisional diagnosis of small bowel infarction and obstruction, we performed exploratory laparotomy. She undergone small bowel segmental resection. The diagnosis was small bowel infaction due to mesenteric vasculitis.