Her physician at the time diagnosed her illness as SLE because of positive antinuclear antibody (ANA) and anti-double-stranded (dsDNA) antibody results and began treatment with 30 mg/day prednisolone (PSL), which was subsequently reduced to 10 mg/day. for anal fistulas twice at 50 and 54 years of age and her symptoms Dynasore were atypical of lupus enteritis. Rabbit Polyclonal to SGK (phospho-Ser422) Colonoscopy was performed again when the patient was 55 years of age because we suspected she had some type of inflammatory bowel disease (IBD). Cobblestone-like inflammatory polyps and many longitudinal ulcers were detected between the descending colon and the cecum. Macroscopic examination strongly suggested CD. Histopathological examination revealed non-caseating granuloma and no evidence of vasculitis, consistent with CD. Introduction of infliximab dramatically relieved the patients melena and abdominal symptoms. Conclusion Diagnostic criteria for CD and SLE overlap, making them difficult to diagnose correctly. It is important to consider CD for patients who have SLE with gastrointestinal manifestations. The pathology of lupus enteritis should be clarified through the accumulation of cases of SLE combined with CD. strong class=”kwd-title” Keywords: Systemic lupus erythematosus (SLE), Crohns disease (CD), Longitudinal ulcer, Aphthous ulcers, Cobblestone-like inflammatory polyps, Non-caseating granuloma, Vasculitis, Infliximab Background Systemic lupus erythematosus (SLE) and Crohns disease (CD) are multisystem diseases characterized by widespread tissue damage [1]. The diseases may have gastrointestinal (GI) manifestations, laboratory results, and radiographic findings that appear similar and consequently differentiating between GI involvement in CD and in SLE may be difficult. There are, in fact, few reports suggesting an association between these diseases [2-8]. We present the case of a patient with SLE and CD who developed continuous GI bleeding and diarrhea that was initially treated as SLE-related colitis to little effect. Case presentation A 55-year-old woman developed rash and arthralgia when she was 19 years old. Her physician at the time diagnosed her illness as SLE because of positive antinuclear antibody (ANA) and anti-double-stranded (dsDNA) antibody results and began treatment with 30 mg/day prednisolone (PSL), which was subsequently reduced to 10 mg/day. Abdominal pain accompanied by diarrhea began to occur intermittently when the patient was aged 30 years. She developed fever at the age of 31 years after swimming in the sea and was admitted to our department for treatment and close examination of her chronic diarrhea. She had a high titer of dsDNA antibody, a positive result for ANA, polyarthritis, rash, and photosensitivity; therefore, we confirmed the diagnosis of SLE using the American Rheumatism Association criteria. Although colonoscopy revealed a linear ulcer, no granuloma was detected by biopsy. Due to melena and abdominal pain, she again underwent colonoscopy when she was 32 and 33 years of age. Although a longitudinal ulcer in the descending colon (D/C) and aphthous ulcers in the transverse colon (T/C) and the ascending colon (A/C) were observed during each examination, biopsy showed only mild inflammation and revealed neither granuloma nor crypt abscess. Her PSL dose was increased to 60 mg/day during each of these hospital visits, because her symptoms were assumed to result from exacerbation of lupus enteritis. However, remission was not achieved. GI symptoms were exacerbated whenever the PSL dose was reduced to 15 mg/day. Colonoscopy performed because of diarrhea when the patient was 39 and 49 years old revealed longitudinal ulcers in D/C and Dynasore ulcerative lesions extended over a wide area from the sigmoid colon to the cecum, no significant finding was obtained by biopsy. The patient was prescribed immunosuppressants, such as azathioprine (AZA), methotrexate (MTX), or tacrolimus (TAC) in addition to PSL 10C20 mg/day and salazosulfapyridine (SASP) 3 g/day at an outpatient unit of the hospital. However, Dynasore the patient repeatedly had melena, positive for immunological fecal occult blood, and positive for inflammatory responses. The patient underwent surgery for anal fistulas twice at 50 and 54 years of age and her symptoms were atypical of lupus enteritis. Colonoscopy was performed again when the patient was 55 years of age because we suspected she had some type of inflammatory bowel disease (IBD). Cobblestone-like inflammatory polyps and many longitudinal ulcers were detected between the descending colon and the cecum (Figure ?(Figure1A).1A). Macroscopic examination strongly suggested CD. Histopathological examination revealed non-caseating granuloma and no evidence of vasculitis (Figure ?(Figure1B),1B), consistent with CD. On November 9, 2009, the patient was hospitalized to begin infliximab treatment for CD at 55 years of age. Hemoglobin (Hb) was 10.9 g/dl (normocytic), white blood cell count was 9.44 103/ml (neutrophilic leukocytes: 90.8%, lymphocytes: 7.4%), and platelets were 4 105/l. Serum blood urea nitrogen (BUN) was Dynasore 18.7 mg/dl and creatinine (Cre) was 0.75 mg/dl, with normal electrolytes, glucose, and liver function tests. Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, and D-dimers were normal. C-reactive protein (CRP) and erythrocyte sedimentation rate were 1.19.