A CASE OF SMALL INTESTINAL MULTIPLE ULCERS WITH CIRCULAR STRICTURE DEVELOPED AFTER HIGH DOSE STEROID AND CYCLOPHOSPHAMIDE THERAPY FOR SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

Abstract

A 36-year-old woman with SLE, having been treated with low dose prednisone since 1975, recieved high dose methylprednisolone and cyclophosphamide for lupus nephritis in December, 1987. In January, 1988, she complained severe abdominal pain, vomitting, diarrhea and fever. X-ray examination showed circularly ulcerative lesion with stricture at oral portion of the jejunum with skipped lesion of anal portion. At laparotomy, another skipped lesion at the ileum was observed and all the lesions were resected. All the superficial ulcerated lesions were histologically diagnosed as non-specific ulcer without any vascular changes. Immunohistochemical study of resected specimens did not revealed any deposits of immunoglobulin. Accordingly, these small intestinal multiple ulcers were thought to be consistent with drug induced lesion occurred during the pulse therapy with steroid and cyclophosphamide for the treatment of SLE.