Clinicians often encounter diagnostic challenges when systemic lupus erythematosus (SLE) manifests through atypical symptoms. While joint pain and skin rashes are common, this case highlights a rare Lupus Enteritis diagnosis presenting as chronic mucus-bloody diarrhea. Recognizing these gastrointestinal signs is crucial for preventing irreversible organ damage.

Case Summary: An Unusual Path to Diagnosis

A 20-year-old woman presented with persistent mucus-bloody diarrhea and a subacute fever. Initially, doctors diagnosed her with infectious enteritis. However, she failed to improve after one week of empiric antibiotic therapy. Her condition worsened, leading to an emergency department visit for high-grade fever and dyspnea. Despite extensive testing, infectious workups remained negative. Consequently, the medical team looked deeper for alternative causes.

Computed Tomography and Lupus Enteritis Diagnosis

Abdominal computed tomography eventually revealed diffuse wall thickening in the stomach, bowel, and urinary bladder. These findings strongly suggested visceral muscle dysmotility syndrome (VMDS). Furthermore, a colonoscopy showed mucosal edema consistent with systemic inflammation. Ultimately, the patient met the clinical criteria for SLE with high disease activity, including lupus nephritis and neuropsychiatric involvement.

Management of Visceral Muscle Dysmotility Syndrome

Prompt intervention is necessary once clinicians confirm a Lupus Enteritis diagnosis. In this case, the team immediately started systemic corticosteroid therapy and stopped all antibiotics. Fortunately, her gastrointestinal symptoms resolved quickly. Nevertheless, the recognition delay led to significant consequences. Imaging later revealed generalized brain atrophy, emphasizing the high stakes of diagnostic speed in SLE.

Conclusion

Chronic mucus-bloody diarrhea can serve as the first sign of SLE. This case underscores the need for doctors to consider autoimmune etiologies in patients with unexplained inflammatory bowel-like symptoms. Therefore, early recognition of VMDS and lupus enteritis remains essential for initiating aggressive therapy and preserving organ function.

Frequently Asked Questions

How does VMDS present in SLE patients?

Visceral muscle dysmotility syndrome usually presents with acute abdominal pain, vomiting, or constipation. This specific case is unique because it presented as chronic mucus-bloody diarrhea, a symptom not previously reported as an initial manifestation.

What imaging is best for a Lupus Enteritis diagnosis?

Computed tomography (CT) is the gold standard for diagnosis. It often reveals circumferential bowel wall thickening, the \"target sign,\" and mesenteric vessel engorgement. It can also identify involvement of other hollow organs like the urinary bladder.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Plangsiri S et al. Delayed Recognition of Systemic Lupus Erythematosus Presenting With Visceral Muscle Dysmotility and Chronic Mucus-Bloody Enteropathy: A Case Report. Am J Case Rep. 2026 Mar 15. doi: 10.12659/AJCR.950774. PMID: 41832597.

Janssens P, et al. Lupus enteritis: from clinical findings to therapeutic management. Orphanet J Rare Dis. 2013;8:67.

Scriffignano S, et al. Visceral muscle dysmotility syndrome in systemic lupus erythematosus. Reumatismo. 2024;76(4):303-308.