gastrointestinal vasculitis due to systemic lupus erythematosus
Gastrointestinal
manifestations of Systemic Lupus Erythematosus: What needs to be considered in an acute setting?. Fig-1: (a)Topogram of abdomen showing thumb-printing (arrow) suggestive of ischemic colitis; (b) Axial sections plain & post contrast showing rectus sheath hematoma (star); (c)target appearance (white arrow) of ascending colon with intramural haemorrhage.
Gastrointestinal
manifestations of Systemic Lupus Erythematosus: What needs to be considered in an acute setting?. Fig-2: Summarises gastrointestinal manifestations of SLE.
gastrointestinale Vaskulitis bei systemischem Lupus Erythematodes
gastrointestinal vasculitis due to systemic lupus erythematosus
gastrointestinale Manifestationen systemischer Lupus Erythematodes Radiopaedia • CC-by-nc-sa 3.0 • de
Gastrointestinal manifestations in patients with systemic lupus erythematosus are common and may involve any region of the gastrointestinal tract or visceral organs.
Clinical presentation
Patients with abdominal or gastrointestinal involvement by systemic lupus erythematosus may have a variety of presentations including abdominal pain, diarrhea, dysphagia, anorexia, ascites, oral ulcers, gastrointestinal bleeding and malnutrition depending on the organs involved and duration of involvement.
Pathology
Systemic lupus erythematosus may affect any part of the gastrointestinal tract and visceral organs:
- peritoneum: ascites is found in up to 10% of patients due to serositis
- gastrointestinal vasculature
- vasculitis causing colitis, mucosal ulceration with hemorrhage or perforation, intestinal ischemia, "watermelon stomach" or gastric antral vascular ectasia, esophageal dysmotility or intestinal pseudo-obstruction
- thrombosis of the intestinal vessels may also occur in association with antiphospholipid syndrome
- mucosa
- mouth ulcers in 50% of patients
- protein-losing enteropathy and fat malabsorption
- associated ulcerative colitis or Crohn disease
- pancreas: pancreatitis
- liver and biliary tract
- hepatomegaly, steatosis, hepatitis, cholestasis, primary biliary cholangitis and eventually cirrhosis may be found.
- Budd-Chiari syndrome which may be associated with antiphospholipid antibodies in SLE
- acalculous cholecystitis and benign biliary stricture
- spleen: splenic infarction
- adrenal glands
Radiographic features
Barium study
- small bowel series: prominent mucosal pattern because of edema, segments of spiculation, fragmentation and clumping of barium
- upper GI series: decreased esophageal peristalsis, reflux, esophageal dilatation
CT
CT findings may include:
- ascites with increased peritoneal enhancement
- circumferential, symmetrical, multisegmented mural thickening usually of the jejunum and ileum with associated submucosal edema (target sign)
- engorgement of mesenteric vessels with a palisade pattern or comb-like appearance
- dilatation of intestinal segments
- mesenteric fat stranding
- diffuse splenic calcification in the typical "onion-skin" pattern due to concentric perivascular lamination of fibrous tissue
- other features and complications of SLE disease may be present (e.g. pancreatitis, intestinal ischemia)
Siehe auch:
Assoziationen und Differentialdiagnosen zu gastrointestinale Vaskulitis bei systemischem Lupus Erythematodes:
gastrointestinale
Manifestationen systemischer Lupus Erythematodes