Lupus Case Study: Initial Presentation with Intestinal Pseudo-Obstruction

According to a case study published in Hindawi, a case study of a 36 year old Black woman provided an unusual and rare example of intestinal pseudo-obstruction presenting as the initial symptom of systemic lupus erythematosus (more commonly known as lupus). Though initially reported in the 1970s, the cause of this presentation remains unclear. Less than two percent of patients present in this manner, which often requires prompt intervention. Unfortunately, because this presentation is rare, many patients are initially misdiagnosed.

About Systemic Lupus Erythematosus

Systemic lupus erythematosus, more commonly known simply as lupus, is an autoimmune disease that is characterized by a red facial rash. An autoimmune illness is one in which the body’s own immune system begins to damage healthy tissue. Certain drugs can induce the disease, but it is most commonly caused by a combination of certain genetic variants, which, when exposed to an environmental trigger, can cause symptoms to begin. Symptoms of lupus include facial rash, swollen, painful joints, fatigue, fever, swollen lymph nodes, chest pain, hair loss, and mouth ulcers. Women are more frequently affected than men. The disease tends to appear in a relapsing-remitting pattern of symptoms. Its symptoms are often vague at first, making diagnosis of lupus more difficult. Treatment may include avoiding sunlight, immune system suppressing drugs, and pain medication. Most people with lupus are able to control their disease effectively without overall lifespan being affected. To learn more about systemic lupus erythematosus, click here.

Intestinal Pseudo-Obstruction

Historically intestinal pseudo-obstruction is more common in patients of Asian origin. It is referred to as pseudo-obstruction because the patient presents with symptoms of an obstruction without a mechanical blockage actually being present. In this case study, the patient presented with symptoms such as vomiting, fever, diarrhea, abdominal pain, and abdominal distension. These symptoms had persisted for five days before the patient was admitted to the hospital. 

The patient was successfully treated with immunosuppressants, and serologic testing confirmed the lupus diagnosis. Imaging revealed several intestinal abnormalities, such as abdominal ascites, bilateral hydroureteronephrosis, and small bowel loops. Generally, prognosis in intestinal pseudo-obstruction is generally good providing that it is correctly diagnosed, and early intervention can produce better outcomes overall.

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