A Case of Systemic Lupus Erythematosus Manifesting First as Mesenteric Vasculitis

ABSTRACT

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.