A case with hydroureteronephrosis accompanied by Lupus Mesenteric Vasculitis

Lupus mesenteric vasculitis is an uncommon and severe complication of systemic lupus erythematosus (SLE). Frequently, these patients exhibit dilated bowel segments, focal or diffuse thickening of the intestinal walls, abnormal contrast enhancement in the intestinal wall, target or double halo, mesenteric edema, engorged mesenteric vessel and ascites in abdominal computerized tomography (CT) imaging. However, these signs lack specificity, limiting the diagnostic role of CT. Intestinal pseudoobstruction in association with hydroureteronephrosis has been previously reported in SLE patients. Here in, we report a case of lupus mesenteric vasculitis occurring in conjunction with hydroureteronephrosis. Presence of hydroureteronephrosis may assist in improving the specificity of CT in lupus mesenteric vasculitis.

PDF

___

Bertsias G, Ioannidis JP, Boletis J, et al. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis. 2008;67:195-205.

Lee CK, Ahn MS, Lee EY, et al. Acute abdominal pain in systemic lupus erythematosus: focus on lupus enteritis (gastrointestinal vasculitis). Ann Rheum Dis. 2002;61(6):547-50.

Ko SF, Lee TY, Cheng TT, et al. CT findings at lupus mesenteric vasculitis. Acta Radiol. 1997;38(1):115-20.

Xu N, Zhao J, Liu J, et al. Clinical analysis of 61 systemic lupus erythematosus patients with intestinal pseudo-obstruction and/or ureterohydro nephrosis: A retrospective observational study. Medicine (Baltimore). 2015;94(4):e419.

Ju JH, Min JK, Jung CK, et al. Lupus mesenteric vasculitis can cause acute abdominal pain in patients with SLE. Nature Rev Rheumatol. 2009;5(5):273-81.

Yuan S, Ye Y, Chen D, et al. Lupus mesenteric vasculitis: clinical features and associated factors for the recurrence and prognosis of disease. Semin Arthritis Rheum. 2014;43(6):759-66.

Chng HH, Tan BE, Teh CL,et al. Major gastrointestinal manifestations in lupus patients in Asia: lupus enteritis, intestinal pseudo-obstruction, and protein-losing gastroenteropathy. Lupus. 2010;19(12):1404-13.

Narváez J, Pérez-Vega C, Castro-Bohorquez FJ, et al. Intestinal pseudoobstruction in systemic lupus erythematosus. Scand J Rheumatol. 2003;32(3):191-5.

Mok MY, Wong RW, Lau CS. Intestinal pseudo-obstruction in systemic lupus erythematosus: an uncommon but important clinical manifestation. Lupus. 2000;9(1):11-8.

Chen YQ, Xue Q, Wang NS. Visceral muscle dysmotility syndrome in systemic lupus erythematosus: case report and review of the literature. Rheumatol Int. 2012;32(6):1701-3.

Taourel PG, Deneuville M, Pradel JA, et al. Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology. 1996;199(3):632-6.