Pôster:

Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune disease potentially severe, frequently disabling with multi-organ involvement. The majority of the patients are women and the course may vary from mild to severe. Although gastrointestinal (GI) symptoms are common, only rarely are due to active organ system involvement from SLE itself. For that minority of patients, SLE activity involving the GI system can be severe and even life-threatening.

Materials and methods

This is a transversal study performed at a university hospital, which main objective was to identify and describe severe gastrointestinal manifestations due to SLE. Eletronic charts were reviewed and the studied variables included: gender, age of SLE onset, pattern of clinical manifestations, age of GI commitment, the GI involvement type, use of previous immunosuppressant and need of immunosuppressant during acute phase.

Results

Out of 1100 patients studied, nine were identified with severe gastrointestinal manifestations specifically due to lupus. All of them required hospitalization during the event. Among these, eight were women. The mean age at diagnosis of lupus was 20.2 years, consistent with the literature, while the mean age of the gastrointestinal manifestation was 31.4 years. Two patients presented protein-losing enteropathy, two chronic intestinal pseudo-obstruction (CIPO), two autoimmune hepatitis, two acute hemorrhagic pancreatitis and one cryptogenic liver cirrhosis. Five patients presented severe gastrointestinal manifestations within the first five years of disease, as described in the literature. Five patients who were taking immunosuppressants during the gastrointestinal event and six patients underwent immunosuppressive treatment to control disease activity. Of these, one case required cyclophosphamide therapy in the NIH scheme, one was treated with azathioprine combined with corticotherapy and the other patients responded to corticosteroid alone, being used at a dose of 1 mg / kg / day or pulse therapy for three days. One patient with acute pancreatitis died due to this manifestation.

Conclusion

Gastrointestinal symptoms may be common in patients with SLE, however severe GI involvement such as CIPO, pancreatitis and significant liver disease are rare. When it occurs may be life-threatening. The cases presented evidenced the severity of GI evolution when caused by SLE activity and drawn attention for the need to be careful when it comes to GI involvement in SLE patients given the fact it can manifest within a broad clinical spectrum.