S5992 A Diagnostic Challenge: Lupus Enteritis in a Young Woman Presenting With Chronic Abdominal Pain

Introduction: The objective of this report is to present a case of a 42-year-old woman who was admitted due to chronic abdominal pain; and to highlight the importance of a combined clinical and ancillary approach in arriving at a diagnosis especially when the usual considerations are eliminated. Case Description/Methods: The patient experienced recurrent acid reflux-like symptoms for 1 year, which progressed to burning epigastric pain associated with loose stools. Computed tomography scan and esophagogastroduodenoscopy (EGD) revealed gastro-duodenitis, and histopathology showed chronic inflammation without dysplasia or H. pylori. Despite treatment with proton pump inhibitors and antispasmodics, symptoms persisted. A repeat computed tomography scan showed unchanged findings, with new evidence of circumferential wall thickening in the proximal ileum. A 7-day course of ciprofloxacin and metronidazole was initiated, and extensive workup for infectious and inflammatory bowel disease yielded unremarkable results. Ascites was also noted, but liver function tests were normal. Repeat EGD and colonoscopy revealed erosive gastritis, duodenitis, ileitis with superficial ulceration, and cecal colitis. Histopathology showed benign lymphoid aggregates and chronic inflammation. Due to history of knee effusions, ascites, oral/vaginal ulcers, and leukopenia; autoimmune markers were requested. Results revealed low C3 levels and a positive antinuclear antibodies (1:40). Hydrocortisone was then started, resulting in significant symptom resolution, and was eventually discharged in stable condition. Discussion: With the fulfillment of the Systemic Lupus International Collaborating Clinics (SLICC) criteria and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria for disease activity, patient was managed as a case of systemic lupus erythematosus with an active disease pattern. Lupus enteritis is a rare manifestation of SLE, primarily affecting females. Common symptoms include abdominal pain, ascites, and diarrhea. The jejunum and ileum are the most commonly involved segments with corticosteroids being the primary management.