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Case report
Successful treatment with intravenous immunoglobulins in a patient with intestinal pseudo-obstruction associated with systemic lupus erythematosus
Tratamiento exitoso con inmunoglobulinas intravenosas en un paciente con pseudoobstrucción intestinal asociada a lupus eritematoso sistémico
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Alex A. Echeverrya, Andrés A. Hormazaa, Juan F. Betancurb, Carlos A. Cañasa, Iván Posso-Osorioa, Gabriel J. Tobóna,c,
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gtobon1@yahoo.com

Corresponding author.
a Unidad de Reumatología, Fundación Valle del Lili, Universidad Icesi, Cali, Colombia
b Departamento de Medicina Interna, Facultad de Medicina, Universidad CES, Medellín, Colombia
c Laboratorio de Inmunología, Fundación Valle del Lili, Cali, Colombia
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Received 30 September 2016. Accepted 16 December 2016
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Table 1. Admission laboratory tests of the patient.
Abstract

Gastrointestinal involvement in patients with systemic lupus erythematosus (SLE) is very diverse, and the frequency of occurrence and location along the digestive tract varies widely. Inflammatory processes secondary to immune complex deposits or vascular events may cause this involvement. One of the most characteristic gastrointestinal manifestations in these patients is the intestinal pseudo-obstruction, which is defined as the ineffective intestinal propulsion that occurs in the absence of mechanical or obstructive factors. This is, however, a rare and poorly understood complication of SLE. The case is presented of a male SLE patient presenting with intestinal pseudo-obstruction, and was successfully treated with steroids and intravenous immunoglobulin. A complete review of the literature and a proposal for the pathophysiology of intestinal pseudo-obstruction are presented.

Keywords:
Intestinal pseudo-obstruction
Systemic lupus erythematosus
Uretero-hydronephrosis
Intravenous immunoglobulins
Resumen

El compromiso gastrointestinal en pacientes con lupus eritematoso sistémico (LES) es muy diverso. Su frecuencia y ubicación a lo largo del tracto digestivo varían ampliamente. Los procesos inflamatorios secundarios a los depósitos de complejos inmunes o eventos vasculares pueden ser los causantes de este compromiso. Una de las manifestaciones gastrointestinales características en los pacientes con LES es la pseudoobstrucción intestinal, que se define como la propulsión intestinal ineficaz que se produce en ausencia de factores mecánicos u obstructivos. Esta es, sin embargo, una complicación rara y poco entendida del LES. En este artículo, reportamos el caso de un paciente masculino con diagnóstico de LES y pseudoobstrucción intestinal, que fue tratado exitosamente con esteroides e inmunoglobulinas intravenosas. Se presenta una revisión completa de la literatura y una propuesta de la fisiopatología de la manifestación.

Palabras clave:
Pseudoobstrucción intestinal
Lupus eritematoso sistémico
Hidronefrosis
Inmunoglobulinas intravenosas

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