Lupus Enteritis as the Initial Presentation of Systemic Lupus Erythematosus: A Diagnostic Challenge Case Report

Abstract

Background: Gastrointestinal (GI) involvement in systemic lupus erythematosus (SLE) is uncommon and often presents with nonspecific symptoms that mimic primary gastrointestinal disorders or postoperative complications, resulting in delayed diagnosis and inappropriate management. Lupus enteritis is a rare but potentially life-threatening manifestation of SLE and may occasionally represent its initial presentation, further complicating the diagnostic process. Case Presentation: A 27-year-old woman presented with a one-year history of persistent nausea, vomiting, and progressive weight loss leading to severe malnutrition. She had previously undergone abdominal surgery for presumed gastrointestinal disease without clinical improvement. During hospitalization, she developed systemic manifestations including alopecia, pancytopenia, hypocomplementemia, and positive antinuclear antibodies, raising suspicion for active SLE. Contrast-enhanced abdominal computed tomography demonstrated small-bowel wall thickening with a target sign and mesenteric vessel engorgement, findings consistent with lupus enteritis. Endoscopic evaluation excluded structural obstruction and malignancy. Based on the integration of clinical, serological, and radiological findings, a diagnosis of lupus enteritis as the initial presentation of SLE was established. Treatment with high-dose corticosteroids followed by cyclophosphamide resulted in rapid clinical, nutritional, and hematologic improvement. Conclusion: Lupus enteritis should be considered in patients with persistent unexplained gastrointestinal symptoms, particularly when accompanied by systemic autoimmune features. Recognition of characteristic radiologic findings together with serologic evidence of disease activity is crucial for timely diagnosis. Early immunosuppressive therapy may prevent unnecessary surgical interventions and reduce the risk of serious complications.