Acute abdomen and lupus enteritis: Thrombocytopenia and pneumatosis intestinalis as indicators for surgery

Bowel symptoms occur often in systemic lupus erythematosus (SLE), but enter ic complications in patients on steroid therapy are rare. We report a case of a 14-year-old Mexican girl with SLE on high-dose steroid therapy complic ated by abdominal vasculitis and small bowel perforation. Accompanying this serious complication were thrombocytopenia and radiographic changes of pne umatosis intestinalis. These findings suggested necrotizing enteritis and p rompted urgent surgery. Four jejunal perforations, pneumatosis intestinalis , and submucosal vasculitis were present in the resected specimen. Persiste nt SLE activity responded to cyclophosphamide, which is indicated in patien ts with digestive symptoms who fail to respond to high-dose steroids.