LUPUS ENTERITIS MASKING AS ACUTE APPENDICITIS IN A 14-YEAR OLD GIRL WITH SYSTEMIC LUPUS ERYTHEMATOSUS A CASE REPORT
Tika Prameswari Hudono,Taralan Tambunan
FKUI RSCM Department of Child Health, Faculty of Medicine University of Indonesia Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Background : Lupus enteritis is a rare manifestation of patients with systemic lupus erythematosus (SLE). It is important to recognize the clinical picture of lupus enteritis due to its obscure gastrointestinal symptoms that may be mistaken for a surgical case.
Case Presentation Summary : A 14-year old female presented with increasing lower right abdominal pain since two days prior to hospital admission. Other symptoms were fever, diarrhea and vomiting. The pain was confined to the umbilical region, did not radiate to other place, no muscular defense and no rebound tenderness. She was already diagnosed as SLE since one year ago and has been routinely consuming oral methylprednisolone and mycophenolate mofetil (MMF). Laboratory investigation revealed anemia, neutropenia, and azotemia. Initial diagnosis was acute appendicitis, SLE, acute kidney injury, and atypical pneumonia. The patient was initially prepared for appendectomy after consulted with pediatric surgery department. However, during inpatient care the abdominal pain slowly subsided. CT scan showed slight pathological dilatation of gastrointestinal region but no swelling of the appendix. The diagnosis of lupus enteritis was established and she was treated conservatively with MMF and oral methylprednisolone. At the end of the fifth hospital stay the abdominal pain subsided and patient was then discharged from the hospital.
Learning Points/Discussion : This case emphasizes that lupus enteritis is the most common cause of abdominal pain in SLE. Identifying the diagnosis of abdominal pain in SLE as lupus enteritis is crucial as there could be non-SLE related abdominal pain such as appendicitis that may lead to a misdiagnosis and cause unnecessary surgery. Interdisciplinary teamwork resulted in successful outcome for the patient.