A Case of Systemic Lupus Erythematodes with Multiple Hemorrhagic Ulcers of the Upper and Lower Digestive Tract

Abstract

A 79-year-old female entered our hospital because of tarry stool. Gastrointestinalscopy revealed multiple hemorrhagic ulcers in the fornix of the stomach. Her laboratory data showed thrombocytopenia and immunological disorders. Making a careful examination, we considered that she had systemic lupus erythematodes with antiphospholipid syndrome.
In spite of prescription of proton pump inhibitor the gastric ulcers were not improved. Furthermore, hematochezia occured to her. Colonoscopy revealed longitudinal ulcers of the left sided colon and biopsy specimen from the ulcer floor showed fibrinoid necrosis histologically. Therefore, we diagnosed the colonic ulcers as ischemic colitis due to lupus vasculitis. It was speculated that the gastric ulcers were also caused by lupus vasculitis. Afterward, gastrointestinl bleeding was continued and the general condition grew worse. We prescribed steroid to suppress vasculitis. As a result, bleeding was stopped and the general condition was getting better.
It was recognized that the gastric and colonic ulcers were healed by the repeated endoscopic examination. It is considered very rare that lupus vasculitis occures multiple hemorrhagic ulcers of the upper and lower digestive tract such as this case.