P2680 - A Case Report of Partial Small Intestinal Obstruction Secondary to Lupus Enteritis With Bowel Ischemia, Portal Vein Thrombosis and Secondary Antiphospholipid Syndrome

Princess Aurea Maderazo, MD, Camille Herrera, MD, Clarise Joyce Vaje, MD, Gay Marjorie Obrado-Nabablit, MD, Rafael Chan, MD, Eric Jason Amante, MD
Manila Doctors Hospital, Metro Manila, National Capital Region, Philippines

Introduction: Lupus enteritis is rare, life-threatening, and a differential among systemic lupus erythematosus (SLE) patients with severe abdominal pain. Due to the high mortality rate of 50% and poor prognosis, a high index of suspicion, early recognition, and prompt treatment are necessary. The co-existence of SLE with antiphospholipid syndrome (APS) portends a poorer prognosis. To date, data is lacking on the incidence of mesenteric vasculitis as a manifestation of SLE in flare in the Philippines.

Case Description/Methods: A 57-year-old Filipino female with a history of recurrent pregnancy loss and chronic left leg swelling presented with a one-month history of progressive bloating, abdominal pain, and vomiting. Of note is a family history of SLE and significant thrombotic illness. Workups showed thrombocytopenia of 30x10^9/L, leukocytosis, microscopic hematuria, pyuria, positive antinuclear antibody screen, decreased complement 3, and borderline positive anti-double-stranded DNA. Imaging studies revealed persistent distal jejunum circumferential enhancing mucosal wall thickening, with associated mesenteric lymphadenopathies and mesenteric reactive changes (Figures A and B), portal vein thrombosis (Figures C and D) with note of varices at the gallbladder fossa (Figure E) and peripancreatic region (Figure F). The patient was diagnosed with lupus enteritis, bowel ischemia, and secondary antiphospholipid syndrome. Worsening symptoms of bowel obstruction and thrombocytopenia led to segmental resection and anastomosis of the jejunum. Post-operatively, lupus activity increased, leading to a dilemma in starting steroids and anticoagulants. The team started hydrocortisone despite the risks of anastomotic failure. Immunomodulatory medications added include mycophenolate mofetil, hydroxychloroquine, and trimethoprim-sulfamethoxazole. Eventually, anticoagulation with fondaparinux was started and overlapped with warfarin. The patient stabilized and was discharged well.

Discussion: We report a case of lupus enteritis, with bowel ischemia and portal vein thrombosis. After a thorough literature search, this is the first locally reported case to date. Due to the scarcity of data, weighing the clinical risk and benefits of interventions was paramount in determining this patient's treatment course. Hopefully, there may be further reports and higher studies soon to ascertain the best management course for these patients.



Disclosures:


Princess Aurea Maderazo, MD, Camille Herrera, MD, Clarise Joyce Vaje, MD, Gay Marjorie Obrado-Nabablit, MD, Rafael Chan, MD, Eric Jason Amante, MD. P2680 - A Case Report of Partial Small Intestinal Obstruction Secondary to Lupus Enteritis With Bowel Ischemia, Portal Vein Thrombosis and Secondary Antiphospholipid Syndrome, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.