Isolated Gastrointestinal Symptoms as Initial Presentation in Systemic Lupus Erythematosus and Its Differential Diagnosis
https://doi.org/10.47836/mjmhs.18.5.30
- Author:
Nurul Akmal Abd Latip
1
;
Azwanis Abdul Hadi
1
;
Mohd Nizamuddin Ismail
2
Author Information
1. Department of Family Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
2. Department of Anaesthesiology, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
- Publication Type:Case Reports
- Keywords:
Systemic lupus erythematosus, Gastrointestinal, Nephritis, Differential diagnosis
- From:Malaysian Journal of Medicine and Health Sciences
2022;18(No.5):218-221
- CountryMalaysia
- Language:English
-
Abstract:
Initial clinical presentation of Systemic Lupus Erythematosus (SLE) is varied as it affects various organs in the body.
While the typical presentation of SLE is mucocutaneous, musculoskeletal and haematological manifestation, gastrointestinal (GI) manifestation is a rare initial presentation of SLE. We discuss the case of a 13-year-old girl who
was diagnosed with SLE after she presented with isolated gastrointestinal symptoms. She presented with vomiting,
diarrhoea, mild colicky abdominal pain and bilateral ankle oedema; and was treated as acute gastroenteritis. She
returned after one week with worsening symptoms. Her full blood count showed bicytopenia; urinalysis had proteinuria and haematuria, and renal profile revealed acute on chronic kidney injury which triggered suspicions of a more
serious disease rather than simple viral gastroenteritis. Further investigations of positive anti-nuclear antibody, low
complements and positive Coombs’s test supported the diagnosis of SLE. The diagnosis of SLE was confirmed when
her renal biopsy reported crescentic lupus nephritis ISN/RPS Class IV. Additional investigation to investigate the
cause of her gastrointestinal symptoms included an ultrasound abdomen which showed minimal ascites and bilateral
renal parenchymal disease. She was planned for colonoscopy but due to the unavailability of paediatric endoscopy,
colonoscopy was postponed. However, her symptoms markedly improved with intravenous Cyclophosphamide
which supported the diagnosis of GI SLE. This case report is to highlight that a patient with symptoms of simple viral
gastroenteritis might have a more serious underlying disease. Even though rare, SLE can present with gastroenteritis
symptoms and is one of the differential diagnoses that should be considered.
- Full text:11.2022my1349.pdf
