Case report
A 40-year old Sudanese female, presented with complaints of facial skin
rash, bilateral small & large joints pain, swelling, Palpitations,
Shortness of breath, Pleuritic chest pain, Hair loss and Muscle pain.
Soon after she has been admitted to our rheumatology unite at Omdurman
military hospital, Khartoum Sudan, the patient developed acute severe
cramping periumbilical abdominal pain associated with abdominal
distension, vomiting & infrequent bloody diarrhoea. Her examination
showed high blood pressure (150/100), pulse rate of 100, temperature
37.5, she has malar rash sparing the nasolabial folds with
hyperpigmented patches, no rash in other sites, broken hair in the
frontal and temporal areas and no nail changed. Cardiovascular
examination revealed short localized Systolic murmur in the mitral area,
chest examination indicated decreased air entry bilaterally with dull
percussion notes, her abdomen was distended, tender left periumbilical
mass, Joints examination showed active synovitis involve
meta-carbophalengial joints bilaterally, Knees & shoulders pain with
passive and active movements. General Investigations were done (Table 1)
suggestive of SLE and the patient abdominal CT showed rounded lumber
mass with a double layer concluded intestinal intussusception.
The patient was seen by the surgical team, underwent laparotomy with
bowel resection, the biopsy
examination report multiple fragments measuring 16 cm with attached
binding 12.5 cm showed congested vascular channels and hypertrophied
muscular fibers with no granulomas or malignancy saw, all these features
consistent with a diagnosis of intussusception, no features of granuloma
or neoplastic cells.
The patient was diagnosed with a case of systemic lupus erythematosus
complicated with intussusception and the possibility of lupus nephritis.
post-operatively the patient received prednisone 30 mg with tapering
Hydroxychloroquine 200 mg per day Azathioprine 50 mg twice per day
Lisinopril 20 mg per day, tonics Bone and gastric protection, although,
the patient therapy showed good response yet, she is still on regular
hemodialysis because renal biopsy done to the patient showed grade 4
lupus nephritis.