Abdominal Pain in SLE

Occurs in up to 30% of Systemic Lupus patients

Differential diagnosis is the same as in patients without SLE, however special consideration should be given to the following disorders.

In Immunosuppressed patients, infection with CMV may cause abdominal pains and GI bleeding.

Peritonitis

An often overlooked cause of abdominal pain in SLE patients.

Although clinical peritonitis is rarely suspected, autopsy suggest that 60 – 70% of patients had an episode of peritonitis.

If CT abdomen showed intraperitonealcollection, paracentesis is warranted to exclude infection.

Mesenteric vasculitis

A life-threating disorder characterized by Lower abdominal pain, generally insidious that may be intermittent for months before development of acute abdomen.

Associated with nausea, vomiting, diarrhea, GI bleeding and fever.

Risk factors include peripheral vasculitis, CNS lupus and anti-phospholipid syndrome.

Diagnosed by imaging and endoscopy:

Treatment

• Patient kept NPO, blood culture obtained

• Broad spectrum antibiotic

• Three days of IV pulse steroid (1- 1.5 gm) plus IV cyclophosphamide (1gm)

• After 7 – 10 days another bolus of cyclophosphamide (750 mg/m2)

• Surgery in case of perforation or failed medical

Pancreatitis

• Occur in 2 – 8 % usually in patients with active SLE

• Presentation does not differ patients without SLE

• May result from vasculitis or thrombosis

• Treatment include IV fluids, NPO

• Systemic steroids may be given

Liver disease

• Hepatomegaly in 50% of patients

• Potential causes: SLE itself (Lupoid –Autoimmune hepatitis) and NSAIDS

Protein-losing enteropathy

Usually occur in young women presenting with diarrhea, profound edema, hypoalbuminemia in absence of nephrotic range protienurea.

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