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Enteritis as initial manifestation of systemic lupus erythematosus in early pregnancy: A case report.

Abstract Lupus enteritis is a rare, severe complication of systemic lupus erythematosus (SLE). We report of a patient who presented with enteritis as manifestation of new-onset SLE during the first trimester of pregnancy.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29702988
OWN - NLM
STAT- MEDLINE
DCOM- 20180514
LR  - 20180516
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 17
DP  - 2018 Apr
TI  - Enteritis as initial manifestation of systemic lupus erythematosus in early
      pregnancy: A case report.
PG  - e0401
LID - 10.1097/MD.0000000000010401 [doi]
AB  - RATIONAL: Lupus enteritis is a rare, severe complication of systemic lupus
      erythematosus (SLE). We report of a patient who presented with enteritis as
      manifestation of new-onset SLE during the first trimester of pregnancy. PATIENTS 
      CONCERNS: The 23-year nulliparous patient was admitted to a district hospital
      with abdominal pain, nausea, vomiting and bloody diarrhea at a gestational age
      (GA) of 10 weeks. Her symptoms improved with symptomatic treatment and she was
      discharged a few days later. At 15 weeks' of gestation she was readmitted. Her
      lab results revealed mild anemia and thrombocytopenia. Ascites, renal failure and
      proteinuria developed. An infectious cause was suspected, but stool samples and
      urine cultures were negative. Diagnostic work-up included abdominal ultrasound,
      gastro- and sigmoidoscopy, magnetic resonance imaging (MRI), and diagnostic
      laparoscopy. Ultrasound and MRI revealed dilated, fluid-filled small bowel loops,
      and increased colonic wall diameters. Mucosal edema and petechiae were detected
      by sigmoidoscopy, and histopathologic examination of the biopsies revealed
      erosive inflammation. Due to progressive deterioration she was transferred to our
      center. In addition to ascites, pleural and pericardial effusions had developed. 
      DIAGNOSIS: Diagnosis of SLE was finally established at GA 16 after an autoimmune 
      workup revealed positive antinuclear, anti- Sm, anti-dsDNA and anti-U1RNP
      antibodies. An interdisciplinary team was set up for her management. She was
      commenced on corticosteroids; response was only partial and necessitated addition
      of cyclosporine. The further clinical course was complicated by anemia, chest
      wall shingles, hypertension, and progressive cervical shortening. Serial
      ultrasound and Doppler examinations revealed notching of the uterine arteries
      with raised pulsatility indices and fetal growth restriction. INTERVENTION: At GA
      35 abdominal pain reoccurred; a decision for delivery was taken. An apparently
      healthy fetus was delivered by cesarian section with good Apgar scores and pH
      (2100g, 9. percentile). The postoperative / postnatal course was unremarkable.
      OUTCOMES: New-onset SLE during pregnancy is rare, as is lupus enteritis. To our
      knowledge, our case is the first report of a combination of both. LESSONS:
      Diagnostic delay occurred a result of symptom overlap and limitations in
      diagnostic imaging. Interdisciplinary teamwork resulted in successful outcome for
      both, mother and fetus.
FAU - Bellou, Anna Maria
AU  - Bellou AM
AD  - Department of Obstetrics and Prenatal Medicine.
FAU - Bos, Dominik
AU  - Bos D
AD  - Department of Internal Medicine.
FAU - Kukuk, Guido
AU  - Kukuk G
AD  - Department of Radiology, University Hospital Bonn, Bonn, Germany.
FAU - Gembruch, Ulrich
AU  - Gembruch U
AD  - Department of Obstetrics and Prenatal Medicine.
FAU - Merz, Waltraut Maria
AU  - Merz WM
AD  - Department of Obstetrics and Prenatal Medicine.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Enteritis/*complications
MH  - Female
MH  - Humans
MH  - Lupus Erythematosus, Systemic/*complications/*diagnosis
MH  - Pregnancy
MH  - Pregnancy Trimester, First
MH  - Young Adult
PMC - PMC5944493
EDAT- 2018/04/29 06:00
MHDA- 2018/05/15 06:00
CRDT- 2018/04/29 06:00
PHST- 2018/04/29 06:00 [entrez]
PHST- 2018/04/29 06:00 [pubmed]
PHST- 2018/05/15 06:00 [medline]
AID - 10.1097/MD.0000000000010401 [doi]
AID - 00005792-201804270-00020 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Apr;97(17):e0401. doi: 10.1097/MD.0000000000010401.