Chronic Diarrhea Unmasking Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by multisystem inflammation, autoantibody formation, and immune complex deposition in nearly any organ system. Age of presentation is typically around the third decade, more likely in females of African, Hispanic, and Asian origin [1]. The most common initial symptoms include fever, arthralgia, and malar rash. Gastrointestinal tract involvement in SLE is characteristically related to adverse medication effects triggering nausea, vomiting, and anorexia, though disease related complications have been described [2]. Gastrointestinal manifestations range from the most lifethreatening lupus mesenteric vasculitis, to lupus enteritis, protein losing enteropathy, intestinal pseudo-obstruction, malabsorption, pancreatitis, and associations with Celiac or Inflammatory Bowel Disease (IBD) [2,3]. While SLE can present in a myriad of ways, to our knowledge, this is the first report of undiagnosed SLE manifesting as a constellation of chronic diarrhea, persistent fever, and pancytopenia.