Introduction: Gastrointestinal (GI) vasculitis among systemic lupus erythematosus (SLE) patients is a rare manifestation confounded with non-specific clinical symptoms and laboratory parameters which delay diagnosis leading to increase morbidity and mortality. This is a case report of a patient with of GI vasculitis who was successfully treated with belimumab Case presentation: We describe a case of a Chinese descent, 24-year-old female who was diagnosed with SLE presenting as malar rash, arthritis, intermittent fever, positive antinuclear antibody (ANA), high titer anti double-stranded DNA and low serum complement. She had gastrointestinal manifestations of colicky abdominal pain, vomiting and diarrhea, with computed tomography scan findings of diffuse mucosal edema involving both small and large intestines, with “target” sign strongly suggestive of GI vasculitis. She initially showed good response to methylprednisolone pulse therapy, but with recurrence of abdominal pain after three months. Repeat abdominal CT showed perforated viscus at the ileal segment with pneumoperitoneum, requiring emergency exploratory laparotomy and colostomy placement. Subsequent clinical course was marked by intolerance to oral steroid requiring regular administration of high dose intravenous steroids. Belimumab was started months after surgery and maintained for two years now. She was successfully shifted to oral prednisone, tapered to lowest dose and underwent uneventful intestinal reanastomosis with closure of colostomy. Discussion: Gastrointestinal (GI) vasculitis is one of the most serious gastrointestinal complications SLE presenting as acute abdominal pain. Our patient was diagnosed based on abdominal CT scan which led to an accurate diagnosis and prompt treatment. Supportive measures, surgery, and belimumab impacted the outcome of this patient. Conclusion Gastrointestinal (GI) vasculitis in SLE has a good outcome with early diagnosis and intervention. Our patient responded well with surgery, steroid and belimumab, a fully human recombinant immunoglobulin G (IgG) 1λ monoclonal antibody. This case report showed that belimumab is a good alternative treatment for lupus GI vasculitis.
Lupus Erythematosus, Systemic ; Lupus

Introduction: Systemic lupus erythematosus (SLE) predominantly affects individuals at peak age of productivity, and medical costs negatively impact on personal, family and community resources. This study aimed to identify annual medical costs and cost predictors among Filipino SLE patients. Methods: Direct annual healthcare costs were determined by survey questionnaires conducted among patients aged > 18 years with minimum one-year illness duration, consecutively seen at the lupus clinics of University of Santo Tomas (UST) Hospital from February to July 2016. Excluded were costs related to biologics. Predictors of cost were estimated using multiple regression analysis. Results: Respondents included 300 SLE patients, 270 females, (94%) age range 11-62 years, mean age 32.84±9.89 at SLE diagnosis, mean disease duration 5.87±5.58 (1-36) years. Median and mean annual direct medical cost was Php 90,950 and Php 133,040 respectively (range Php 17,440859,050). Annual cost was higher in those requiring dialysis (n=16) compared to those not requiring dialysis (n=150) vs those without nephritis (n=134), (median Php 595,400 vs 144,700 vs 55,020 respectively), p<0.001. End stage renal disease (ESRD) (p<0.001), mycophenolate use (p<0.001), high frequency of clinic visits (p=0.016) and lupus-related hospitalizations (p=0.018) were independent variables which significantly contributed to annual costs. Conclusion Nephritis especially if requiring dialysis was the most important cost predictor in this cohort, increasing annual costs to seven-fold. Mycophenolate use, lupusrelated hospitalizations and clinic visits increased annual costs by 147.2%, 173.8% and 2.6% respectively. This study reinforces the need for early recognition and aggressive disease control to prevent complications especially in those with renal involvement.
Hospitalization ; Nephritis ; Lupus Erythematosus, Systemic