An Uncommon Manifestation of Systemic Lupus Erythematosus as Lupus Enteritis With Intestinal Pseudo-Obstruction and Invasive Candidiasis

Systemic lupus erythematosus (SLE) is a multifaceted autoimmune disorder, occasionally presenting with rare complications like lupus enteritis (LE) and intestinal pseudo-obstruction (IPO). We present a unique case of a 32-year-old woman with LE and IPO, complicated by invasive candidiasis, as an initial manifestation of SLE. The patient presented with a 15-day history of abdominal pain, vomiting, and poor oral intake, and was initially misdiagnosed with infective enterocolitis. Examination revealed abdominal distension and absent bowel sounds due to IPO, alongside severe hypokalemia and signs of intra-abdominal hypertension (IAH), necessitating ventilator support. Subsequent workup confirmed SLE with LE and associated lupus nephritis (LN). The patient's condition was further complicated by disseminated invasive candidiasis involving multiple organs, including the bloodstream, chorioretinitis, and endocarditis. Despite her critical state, intensive multidisciplinary care, including high-dose steroids, antifungal therapy, and supportive measures, led to her recovery and discharge after a 51-day ICU stay. This case underscores the complexity of diagnosing SLE when it presents with non-specific symptoms. The concomitant occurrence of LE, IPO, and invasive candidiasis is particularly rare, highlighting the need for high clinical suspicion in the presence of SLE serological activity. The presence of invasive candidiasis was likely secondary to gut translocation due to LE-associated inflammation, a phenomenon not previously well-documented. LE can manifest as the primary and sole presentation of SLE, even in the absence of typical lupus features. Prompt immunomodulatory treatment and comprehensive care are essential for a favorable outcome. Clinicians should consider invasive candidiasis in SLE patients with acute GI involvement, particularly in the presence of LE.