Abstract | RATIONALE: PATIENT CONCERNS: DIAGNOSES: Computed tomography and Tc-labeled human serum albumin scintigraphy revealed abnormal findings, and a diagnosis of lupus enteritis and PLE was made. Steroid treatment was continued but no significant improvement was observed, and the patient was referred and admitted to our hospital. Double-balloon enteroscopy revealed multiple ischemic stenoses and mucosal necroses in the small intestine, suggesting that PLE was associated with ischemic enteritis due to antiphospholipid syndrome. The patient received steroids, immunosuppressive drugs, and antithrombotic therapy, with no improvement in symptoms. Thus, the disease was judged to be refractory and resistant to medical therapy, and the patient was indicated for surgical treatment. INTERVENTIONS: Partial small intestinal resection was performed by removing the segment of the small intestine presenting PLE lesions, and a double-end ileostomy was created. OUTCOMES: Multiple stenotic lesions were confirmed in the resected segment. Histopathology evaluation revealed marked inflammatory cell infiltration in the intestinal tract wall and recanalization of the vessels, suggesting a circulatory disorder caused by vasculitis and antiphospholipid syndrome. Postoperatively, the clinical course was good. Serum albumin levels and body weight increased as nutritional status improved significantly. Secondary enteroenterostomy with ileostomy closure could be performed at 2 months after the initial surgery. LESSONS: Timely surgical treatment can be successful in managing therapy-resistant and refractory PLE in patients with SLE.
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Authors | Kazuma Iwasaki, Mitsuaki Morimoto, Gaku Ota, Koji Koinuma, Hisanaga Horie, Naohiro Sata, Takeo Nakaya |
Journal | Medicine
(Medicine (Baltimore))
Vol. 97
Issue 30
Pg. e11357
(Jul 2018)
ISSN: 1536-5964 [Electronic] United States |
PMID | 30045258
(Publication Type: Case Reports, Journal Article, Retracted Publication)
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Chemical References |
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Topics |
- Adolescent
- Digestive System Surgical Procedures
(methods)
- Dissection
(methods)
- Female
- Humans
- Hypoalbuminemia
(diagnosis, etiology)
- Immunologic Tests
(methods)
- Intestine, Small
(surgery)
- Lupus Erythematosus, Systemic
(complications, immunology)
- Male
- Protein-Losing Enteropathies
(blood, diagnosis, etiology, surgery)
- Radionuclide Imaging
(methods)
- Serum Albumin
(analysis)
- Treatment Outcome
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