Systemic Lupus Erythematosus (SLE) is a multi-systemic autoimmune disorder. Fifty percent will have gastro- intestinal symptoms and 1 to 4% have jaundice.

Two Filipino adolescents with uncommon presentation of SLE are reported: a 14-year old female with intermittent epigastric pain and a 17-year-old male with jaundice. Epigastric pain and jaundice are uncommon presentations in patients with SLE. A high index of suspicion is needed and SLE must be considered in the presence of other clinical and immunologic features.

Key Words: lupus, jaundice, epigastric pain

A 12-year-old female had a three-year history of fever, non-bilious vomiting and abdominal pain. Upper gastrointestinal series showed a filling defect at the duodenum. Esophagogastroduodenoscopy exhibited circumferential mass extending from the duodenal bulb to the 2nd part of the duodenum which on histology disclosed chronic granulomatous inflammation. Chest X-ray suggested miliary tuberculosis; endotracheal tube aspirate was PCR positive for Mycobacterium tuberculosis. Patient was diagnosed as disseminated tuberculosis of the duodenum and lungs. Quadruple anti-tuberculosis medication was started but patient succumbed to nosocomial sepsis.
Tuberculosis, Miliary ; Gastric Outlet Obstruction ; Granuloma ; Inflammation

Objective: To describe the clinical, biochemical, microbiologic, radiologic and histological features and outcome of intestinal TB. Methods: Medical records of patients diagnosed with intestinal TB were reviewed. Cases were considered bacteriologically-confirmed if intestinal tissue was positive on smear culture or polymerase chain reaction (PCR); and clinically-diagnosed if with clinical, histologic, and radiologic evidence of extra-pulmonary TB. Results: Fifteen patients [Mean (SD) age: 13 (4) years; 53% females] were included. One was bacteriologically-confirmed; and fourteen were clinically-diagnosed. Fever (87%) and abdominal pain (73%) were commonly seen. Seven (47%) had anemia, 5 (33%) leukocytosis and 10 (71%) hypoalbuminemia. Eleven (73%) were positive on smear or TB PCR of various specimens. Nine of 10 (90%) patients with an abdominal CT scan had thickening of bowel loops. Three with intestinal biopsy demonstrated caseation granuloma. Fourteen patients were given quadruple anti-TB medications. Six had surgery, 8 had no disease-related complications, 4 died of sepsis and 3 were lost to follow up. Conclusion Intestinal TB presents with non-specific clinical and laboratory features. Radiologic findings may provide a clue to the diagnosis. Histologic confirmation in intestinal tissue was only seen in a few cases. The prognosis was favorable for patients who completed the anti-TB treatment.
Tuberculosis, Extrapulmonary ; Mycobacterium tuberculosis

Objective: To determine the validity of serum H. pylori IgG in the detection of H. pylori-associated gastroduodenitis in patients with gastrointestinal symptoms. Methods: Cross-sectional study which included consecutive patients 1-18 years old with upper gastrointestinal symptoms who underwent esophagogastroduodenoscopy. H. pylori infection was diagnosed by positive tests for both rapid urease test (RUT) and Giemsa stain of gastric biopsies. H. pylori IgG (ELISA) serology was also performed. Results: Twenty-five patients [Mean (SD) age: 12 (4.5) years, 68% females] were included. Majority presented with epigastric pain (64%) and had endoscopic gastritis (84%). Four patients had ulcers (1 antral, 3 duodenal). Giemsa stain was positive in 16 (64%) patients and RUT in one. Prevalence of H. pylori infection was 4%. Serum H. pylori IgG test was positive in two; borderline in three with a 100% sensitivity, 80% specificity, and a positive and negative likelihood ratio of 10.9 and 0.6. Conclusion The present study showed a low prevalence of H. pylori infection, thus, the validity of the H. pylori serology could not be adequately evaluated. We presently could not recommend the serum IgG in the detection of H. pylori gastroduodenitis in our setting.