A 28-year-old Southeast Asian non-pregnant woman with asthma and prior cholecystectomy presented to the emergency department with acute watery diarrhoea, intermittent abdominal pain and vomiting. Apart from abdominal tenderness, the rest of the physical examination was unremarkable. She had leucocytosis, alkaline phosphatase elevation and exudative ascites. Radiological imaging ruled out biliary leak and was only significant for circumferential small and large bowel thickening. Upper endoscopy and colonoscopy showed normal duodenal and colonic mucosae. Both infectious and malignancy workup were also unremarkable. Bereft of other systemic symptoms, autoimmune pathology was initially deemed unlikely; however, autoimmune workup revealed positive antinuclear antibody, double-stranded DNA, anti-Smith antibody, antinuclear ribonucleoprotein and hypocomplementaemia. With multidisciplinary collaboration, the patient was initiated on high-dose steroids, which dramatically improved her symptoms. She was discharged home with a steroid taper, and at 3 months of follow-up with her rheumatologist, she was continued on steroids and hydroxychloroquine.
- systemic lupus erythematosus
- small intestine
- connective tissue disease
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Contributors KBL was the attending physician during the hospitalisation course of the patient; he guided the treatment plan and also helped with design and planning of the case report. Final edition was supervised by him. GS was directly involved with the case; she contributed to the acquisition of data, analysis, interpretation of the data and case writing. JLP was involved in the editing of the final draft and also contributed to reviewing the literature and formulating the discussion. He was directly involved in the care of the patient. EQ was involved in the acquisition of consent, writing and editing the draft. Also, he was directly involved in the care of the patient during her hospital stay. He also took care of the submission of the case.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.