12th Ljudevit Jurak International Symposium on
Comparative Pathology
Zagreb
June 1-2, 2001
 

POSTER PRESENTATION
VENULITIS RESULTING IN ACUTE ABDOMEN AND UNTREATABLE INTESTINAL HEMORRHAGE AS FIRST SIGN OF A SYSTEMIC LUPUS ERYTHEMATOSUS 
R. Bussani,  P. Cusati,  D. Camilot,  C. Trevisiol*,  D. Codrich*, F. Silvestri
Department of Pathological Anatomy, University of Trieste, Trieste, Italy
*IRCCS ”Burlo Garofalo”, Trieste, Italy
Systemic lupus erythematosus (SLE) is a systematic disorder which may involve the gastrointestinal tract. Symptoms may vary from non-specific anorexia, nausea and abdominal pain to major complications such as hemorrhagic enteropathy and intestinal infarction.
A 17-year-old boy was hospitalised for severe abdominal pain and high fever mimicking perforated appendicitis. The operative findings revealed a nonbacterial peritonitis with a gangrenous necrotic appendix and a large amount of hemorrhagic ascitis. In the early postoperative period, persisting high fever and abdominal pain, the patient developed  rectal hemorrhage with a skin rash. A vasculitic screen, showing low complement titres, thrombocytopenia and positive specific lupus autoantibodies, allowed the suspicion of SLE. Histology of the appendix confirmed necrotizing vasculitis. High-dose steroid and immunoglobulin were started. Clinical and instrumental examinations failed to uncover the site of the bleeding. In the 4th postoperatively day, a new massive episode of rectal bleeding required emergency laparotomy, revealing a diffuse edema and the dilatation of the last portion of the ileum and cecum with an engorgement of the mesenteric vessels. An ileocolonic anastomosis was performed.
Examination of the resected specimen showed several superficial longitudinal microulcers on the antimesenteric aspect of the ileum. Some blood clots were adhering to the ulcers in the ileum and in the colon. The more distal colon was conspicuously edematoused. The histologic examination showed an intensively edematous and hemorrhagic submucosa. The majority of the submucosal arteries and arterioles were normal. In contrast, the submucosal venules showed transmural inflammation with focal fibrinoid necrosis. Immunoperoxidase-stained sections confirmed the presence of fibrinogen in the walls of the venules. The patient was treated with cyclophosphamide and a decreasing oral dose of corticosteroids. At the 7 month follow-up he had no clinical symptoms, vasculitis screen were negative on 5 mg prednisolone daily.
Poster Presentation