Mesenteric vasculitis in a juvenile systemic lupus erythematosus patient

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorALBUQUERQUE-NETTO, Adao F.
dc.contributor.authorCAVALCANTE, Erica G.
dc.contributor.authorSALLUM, Adriana M. E.
dc.contributor.authorAIKAWA, Nadia E.
dc.contributor.authorTANNURI, Uenis
dc.contributor.authorSILVA, Clovis Artur Almeida da
dc.date.accessioned2014-01-28T22:25:58Z
dc.date.available2014-01-28T22:25:58Z
dc.date.issued2013
dc.description.abstractLupus mesenteric vasculitis (LMV) is a rare cause of acute abdominal pain. Few cases of LMV have been reported in adults, children and adolescents. However, to our knowledge, the prevalence of that severe vasculitis in a pediatric population with lupus is yet to be studied. This study reviewed data from 28 consecutive years and included 5,508 patients being followed up at the hospital of the Faculdade de Medicina of the Univesidade de Sao Paulo (FMUSP). We identified 279 (5.1%) patients meeting the American College of Rheumatology classification criteria for the diagnosis of systemic lupus erythematosus (SLE), one of whom (0.4%) had LMV. That male patient was diagnosed with SLE at the age of 11 years. At the age of 13 years, he was hospitalized with diffuse and acute abdominal pain, nausea, bilious vomiting, abdominal distension, rebound tenderness, and abdominal muscle guarding. The patient underwent laparotomy immediately, and segmentary intestinal ischemia with intestinal wall edema and adhesions were identified. Partial small bowel resection with lysis of the adhesions was performed, as were pulses of intravenous methylprednisolone. The histopathologic analysis evidenced mesenteric arteritis. After 13 days, the diffuse and intense abdominal pain recurred, and the patient underwent a new laparotomy, during which adhesive small bowel obstruction with intestinal gangrene was identified. New intestinal resection was performed, and the patient received pulses of intravenous methylprednisolone and infusion of immunoglobulin. Thus, LMV is a rare and severe abdominal manifestation of the pediatric population with lupus, and can be the only manifestation of disease activity In addition, this study stresses the importance of the early diagnosis and immediate treatment.
dc.description.abstractA vasculite mesentérica lúpica (VML) é uma rara causa de dor abdominal aguda. Há poucos relatos de caso demonstrando VML em adultos e, particularmente, em crianças e adolescentes. No entanto, para o nosso conhecimento, a prevalência dessa grave vasculite em uma população pediátrica com lúpus ainda não foi estudada. Portanto, dados de 28 anos consecutivos foram revisados e incluídos 5.508 pacientes em seguimento no Hospital da Faculdade de Medicina da Univesidade de São Paulo (FMUSP). Identificamos 279 (5,1%) casos que preencheram critérios de classificação diagnóstica do American College of Rheumatology para lúpus eritematoso sistêmico (LES) e um (0,4%) desses apresentou VML. Este paciente recebeu diagnóstico de LES aos 11 anos de idade. Aos 13 anos foi hospitalizado com dor abdominal difusa e aguda, náuseas, vômitos biliosos, distensão e rigidez abdominal, com descompressão brusca positiva. O paciente foi prontamente submetido à laparotomia exploradora, identificando isquemia intestinal segmentar, com edema de parede intestinal e aderências. Foi realizada ressecção parcial de intestino delgado, com lise das aderências e pulsoterapia com metilprednisolona. A análise histopatológica identificou arterite de vasos mesentéricos. Após 13 dias, apresentou recorrência de dor abdominal difusa intensa, sendo novamente submetido à laparotomia exploradora, identificando obstrução em intestino delgado por aderências, com gangrena intestinal. Nova ressecção intestinal foi realizada, além de pulsoterapia com metilprednisolona e infusão de imunoglobulina. Portanto, VML é uma rara e grave manifestação abdominal na população com lúpus pediátrico, e pode ser a única manifestação de atividade da doença. Além disso, este estudo reforça a importância do diagnóstico precoce e do tratamento imediato.
dc.description.indexMEDLINE
dc.description.sponsorshipFAPESP [08/58238-4]
dc.description.sponsorshipCNPQ [300248/2008-3]
dc.description.sponsorshipFederico Foundation
dc.identifier.citationREVISTA BRASILEIRA DE REUMATOLOGIA, v.53, n.2, p.219-222, 2013
dc.identifier.doi10.1590/S0482-50042013000200011
dc.identifier.issn0482-5004
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/4183
dc.language.isoeng
dc.language.isopor
dc.publisherELSEVIER SCIENCE INC
dc.relation.ispartofRevista Brasileira de Reumatologia
dc.rightsopenAccess
dc.rights.holderCopyright ELSEVIER SCIENCE INC
dc.subjectVasculitis
dc.subjectAdolescent
dc.subjectCutaneous lupus erythematosus
dc.subjectVasculite
dc.subjectAdolescente
dc.subjectLúpus eritematoso cutâneo
dc.subject.otheracute abdominal-pain
dc.subject.otherindex
dc.subject.wosRheumatology
dc.titleMesenteric vasculitis in a juvenile systemic lupus erythematosus patient
dc.title.alternativeVasculite mesentérica em paciente com lúpus eritematoso sistêmico juvenil
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.author.externalALBUQUERQUE-NETTO, Adao F.:Pontificia Univ Catolica Sao Paulo, Fac Ciencias Med & Saude, Sao Paulo, Brazil
hcfmusp.citation.scopus12
hcfmusp.contributor.author-fmusphcERICA GOMES DO NASCIMENTO CAVALCANTE
hcfmusp.contributor.author-fmusphcADRIANA MALUF ELIAS SALLUM
hcfmusp.contributor.author-fmusphcNADIA EMI AIKAWA
hcfmusp.contributor.author-fmusphcUENIS TANNURI
hcfmusp.contributor.author-fmusphcCLOVIS ARTUR ALMEIDA DA SILVA
hcfmusp.description.beginpage219
hcfmusp.description.endpage222
hcfmusp.description.issue2
hcfmusp.description.volume53
hcfmusp.origemWOS
hcfmusp.origem.pubmed23856801
hcfmusp.origem.scieloSCIELO:S0482-50042013000200011
hcfmusp.origem.scopus2-s2.0-84881532524
hcfmusp.origem.wosWOS:000322292500011
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
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hcfmusp.remissive.sponsorshipCNPq
hcfmusp.remissive.sponsorshipFAPESP
hcfmusp.remissive.sponsorshipFederico Foundation
hcfmusp.remissive.sponsorshipCNPq
hcfmusp.remissive.sponsorshipFAPESP
hcfmusp.remissive.sponsorshipFederico Foundation
hcfmusp.scopus.lastupdate2024-05-10
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