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Lupus mesenteric vasculitis can cause acute abdominal pain in patients with SLE

Abstract

Lupus mesenteric vasculitis (LMV) is a unique clinical entity found in patients who present with gastrointestinal manifestations of systemic lupus erythematosus, and is the main cause of acute abdominal pain in these patients. LMV usually presents as acute abdominal pain with sudden onset, severe intensity and diffuse localization. Other causes of abdominal pain, such as acute gastroenteritis, peptic ulcers, acute pancreatitis, peritonitis, and other reasons for abdominal surgery should be ruled out. Prompt and accurate diagnosis of LMV is critical to ensure implementation of appropriate immunosuppressive therapy and avoidance of unnecessary surgical intervention. The pathology of LMV comprises immune-complex deposition and complement activation, with subsequent submucosal edema, leukocytoclastic vasculitis and thrombus formation; most of these changes are confined to small mesenteric vessels. Abdominal CT is the most useful tool for diagnosing LMV, which is characterized by the presence of target signs, comb signs, and other associated findings. The presence of autoantibodies against phospholipids and endothelial cells might provide information about the likelihood of recurrence of LMV. Immediate, high-dose, intravenous steroid therapy can lead to a favorable outcome and prevent serious complications such as bowel ischemia, necrosis and perforation.

Key Points

  • Lupus mesenteric vasculitis (LMV) is the main cause of acute abdominal pain in patients with systemic lupus erythematosus

  • LMV can result in life-threatening complications such as bowel infarction and perforation Abdominal CT is the most useful tool for the early and accurate diagnosis of LMV

  • Immune complex deposition in intestinal blood vessel walls has a role in the initiation of complement activation and vascular changes, such as extravasation and thrombosis

  • Early immunosuppressive treatment with high-dose steroids reduces the mortality and morbidity associated with LMV

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Figure 1: CT findings in LMV.
Figure 2: Pathological findings of LMV associated with its clinical features.
Figure 3: Proposed pathophysiological mechanisms of LMV.

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Acknowledgements

This work was supported by the Korea Science and Engineering Foundation and by funding from the Ministry of Education, Science and Technology (R11-2002-098-05001-0). We thank Professor Jae Myung Park for sincere, helpful comments as a gastroenterologist. We are very grateful to Jae Ho Shin and Seung Ah Yahng for their expert English translation. Ji Hyeon Ju and Jun Ki Min contributed equally to authorship of this article.

D. Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Ju, J., Min, JK., Jung, CK. et al. Lupus mesenteric vasculitis can cause acute abdominal pain in patients with SLE. Nat Rev Rheumatol 5, 273–281 (2009). https://doi.org/10.1038/nrrheum.2009.53

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