AB0856 CHRONIC INTESTINAL PSEUDO-OBSTRUCTION WITH HYDRONEPHROSIS: A CASE REPORT ON SUCH DISABLING AND RARE COMPLICATION OF LUPUS

Background: Chronic intestinal pseudo-obstruction can be a rare complication of systemic lupus erythematosus. It is often late to identified in contrast other commoner organs involvement erythematosus such as nervous system, joint and kidney. Objectives: To report case uncommon gastrointestinal lupus, with associated hydronephrosis at the ureter, treatment delay. Methods: We chronic pseudo-obstruction. Results: A 34 year old, ten-year history nephritis, presented recurrent abdominal pain diarrhoea past nine months. The patient had just been diagnosed end-stage renal failure ago, on regular haemodialysis. For ten years, was not able tolerate immunosuppressant due multiple episodes infections, including shin carbuncle, herpes zoster, breast abscess catheter-related candida/bacterial infections. However, did have any major manifestations for years. apyretic. Multiple stool cultures were negative Clostridium difficile. radiography showed dilated small bowel diffuse thickening large bowels computed tomography. Bilateral uretero-hydronephrosis also noted without evidence obstructive uropathy imaging. Ileocolic resection done presumed obstruction ileocolic biopsy reveal granuloma, malignancy or vasculitis except non-specific inflammation cecum. Cytomegalovirus inclusion body absent well. Tuberculosis culture negative. Oesophagoduodenoscopy colonoscopy offered view persistent unexplained loose pain. But unremarkable findings from specimens bowels. Second relook initial hemicolectomy specimen special actin immunostain smooth muscle revealed degenerative changes muscularis propria. These evidenced by cytoplasmic vacuolation, atrophy pyknotic nucleus cells surrounding oedema. Smooth dysmotility could underlying pathology this presentation. responded well intravenous immunoglobulin followed azathioprine addition prednisolone prokinetic agent. Conclusion: Prompt recognition pivotal prevented unnecessary surgical intervention earlier. potentially reversible. Long term prognosis entity is, however, varying. Disclosure Interests: None declared