A 38-year-old Japanese woman, who had fulfilled the revised American College of Rheumatology
criteria for systemic lupus erythematosus (SLE), and whose disease had been controlled
with oral prednisolone at a dose of 5 mg/day for a year, reported a 3-day history
of nausea and vomiting. On admission, laboratory tests showed a lactate dehydrogenase
level of 610 IU/l, an erythrocyte sedimentation rate of 35 mm/hour, a positive antinuclear
antibody (titer 1 : 40), and decreased levels of complements (C3, 32 mg/dl; C4, 6
mg/dl; CH50, 24.4 U/dl). Gastroscopic examination revealed a stenosis of the pyloric
antrum with no mucosal lesion (Figure [1]). A computed tomographic scan demonstrated diffuse thickening of the antral wall
with marked enhancement by contrast material on the serosal side (Figure [2]), in addition to mild hydronephrosis, thickened wall of the gallbladder, and a small
amount of ascites. The lupus peritonitis and cholecystitis was thought to be the most
likely cause of the antral stenosis.
Figure 1 Gastroscopic examination showed stenosis of the pyloric antrum with no mucosal lesion.
Figure 2 A computed tomography (CT) scan of the abdomen demonstrated diffuse thickening of
the antral wall with marked enhancement by contrast material on the serosal side.
The patient was treated with intravenous prednisolone at a dose of 20 mg/day and the
symptoms subsided immediately. Endoscopic examination and a computed tomographic scan
within 2 weeks after the introduction of intravenous steroids showed no evidence of
antral wall thickening or stenosis. The patient has been free from symptoms over 1
year of follow-up.
Lupus peritonitis and cystitis is an unusual manifestation of SLE. In previously reported
cases, involvement of the gut has been primarily in the small intestine [1]
[2]
[3] and rarely in the stomach [4]
[5]. The finding in our patient indicates that serositis can occur focally on the gastric
serosa in SLE, as shown previously at laparotomy [5], which results in stenosis of the pyloric antrum. A contrast computed tomography
(CT) scan and endoscopic examination are useful for the differential diagnosis. Physicians
should consider this unusual cause of antral stenosis which showed adequate remission
with intravenous steroid.
