Mesenteric Vasculitis in a Systemic Lupus Erythematosus Patient with a Low Sledai: An Uncommon Presentation

Gastrointestinal manifestations are common in patients with systemic lupus erythematosus (SLE), and the incidence of these conditions varies according to the methods of evaluation and the type of manifestation; the incidence of gastrointestinal manifestations varied between 15% and 75% in the majority of previously published studies. The clinical picture may vary from minor symptoms, such as oral ulcers, dysphasia, nausea and vomiting, to more serious conditions, including pancreatitis, hepatitis and mesenteric vasculitis. Mesenteric vasculitis is uncommon among gastrointestinal complications (2.2-9.7%) but may cause enhanced complications and mortality if it is not carefully diagnosed and promptly treated. Gastrointestinal vasculitis is characterized by ischemia of the digestive tract; this ischemia is caused by the deposition of circulating immune complexes. Clinically, this vasculitis presents with diffuse abdominal or colonic pain, vomiting and fever. The physical examination demonstrates abdominal pain upon touching, which may indicate peritoneal irritability. Gastrointestinal vasculitis does not usually appear as an isolated manifestation but is generally associated with other clinical manifestations of the illness and SLE activity. Consequently, the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score is generally high in patients with gastrointestinal vasculitis. In the present study, we describe an unusual case of a lupus patient with mesenteric vasculitis who presented without any evidence of the illness, which is usually found in this clinical situation.