Deepa Budh, MD1, Jamil M. Shah, MD2, Ali Chaudhri, MD3, Narendra Nithan, MD3 1SBH Health System, Bronx, NY; 2Brooklyn Hospital Center, Brooklyn, NY; 3St. Barnabas Hospital, Bronx, NY
Introduction: Systemic Lupus Erythematosus (SLE) is a multisystem disorder. Ischemic lupus colitis is rare and high clinical suspicion is needed due to the high mortality rate of this condition. Here, we present a rare case of ischemic lupus colitis in a young woman with multisystem involvement.
Case Description/Methods: A 28-year-old female, with a past history of asthma, SLE and sickle cell trait, presented with agitation, dyspnea, and pedal edema for the past few days. Anemia, hypoglycemia, hyperkalemia, acute myocardial ischemia and elevated ANA level were seen on initial workup. The patient was emergently intubated for acute respiratory failure and treatment was initiated for severe CHF, renal failure, and pneumonia. The patient received antibiotics, plasmapheresis, pulse steroids, dual antiplatelets and other immunomodulators. During hospital course, patient had coffee-ground emesis, hematochezia, abdominal distension, and a drastic drop in hemoglobin from 7.3 to 5.8 g/dl. Abdominal X-ray showed dilated colon with proximal and distal small bowel gas-filled loops. CT scan of the abdomen showed diffuse colitis, mild ascites without active GI bleeding. Upper endoscopy showed 3 actively bleeding lesions in the body, fundus and cardia of the stomach. Hemostasis was achieved in the fundus and body with placement of 5 clips and epinephrine. However, bleeding from gastric cardia was not amenable to intervention and she underwent left gastric artery embolization. Upon stabilization, colonoscopy was performed which showed patchy submucosal hemorrhages with skip lesions, from the sigmoid to the ascending colon with no ulcers or polyps (Figure 1). Biopsy showed colonic tissue with mild ischemic changes, lamina propria edema with no fibrinoid, necrotizing or small vessel vasculitis. Vasculitis of medium to large vessels was not ruled out (Figure 2). The patient received steroids and blood transfusions, and the hemoglobin stabilized to 8.5 g/dl. However, the patient succumbed to death secondary to cardiac arrest.
Discussion: SLE is an autoimmune disorder with high prevalence in females and grave prognosis in African American women. It may involve all organ systems. Colon involvement is rare and presents as abdominal pain or complications of intestinal ischemia, pseudo-obstruction, or bleeding. A high index of clinical judgment for diagnosis with the help of endoscopy and biopsy. Medical and/or surgical interventions are used to control the disease with immunomodulators, fluids, antibiotics, and pain management.
Figure: Figure 1 (A and B) : endoscopic findings) Figure 2 (A, B, and C) : histopathology images - H&E stain
Deepa Budh indicated no relevant financial relationships.
Jamil Shah indicated no relevant financial relationships.
Ali Chaudhri indicated no relevant financial relationships.
Narendra Nithan indicated no relevant financial relationships.
Deepa Budh, MD1, Jamil M. Shah, MD2, Ali Chaudhri, MD3, Narendra Nithan, MD3. P1236 - Ischemic Colitis: An Unusual Manifestation of Systemic Lupus Erythematosus, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.