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The small vessel mesenteric vasculitis (MV) has a global prevalence ranging from 0.2% to 9.7% among patients with lupus and 29% to 65% in those with lupus and acute abdominal pain. 1–4 The pathology of Lupus MV comprises immunecomplex deposition and complement activation, with subsequent submucosal edema, leukocytoclastic vasculitis and thrombus formation. 1, 5 Abdominal CT scan is thought to be the most useful modality for the early diagnosis of mesenteric ischemia6 and can demonstrate prominence of mesenteric vessel with a palisade pattern supplying dilated loops (comb sign), ascites, and diffuse or focal circumferential bowel wall thickening, as well as submucosal edema with abnormal enhancement (target sign). Gasteroendoscopy and colonoscopy sometimes reveal findings of ischemia and ulceration. 1, 5 Because lupus mesenteric vasculitis typically involves small vessel of bowel submucosa, mesenteric angiography is not usually diagnostic. 5 However, angiography can be helpful in ruling out larger vessel that causes mesenteric ischemia such as polyarthritis nodosa. Mesenteric vasculitis has a high mortality rate with a reported estimate 50% mortality depending of timing and institution of corticosteroid treatment and surgery. 2 Medical treatment involves immediate, high-dose, intravenous steroid therapy1 and if a rapid response to medical treatment is not achieved, surgical intervention is mandatory. 7 In this patient, in addition to supportive managements, intravenous methylprednisolone (1 gr daily for 3 days) followed by oral prednisolone 50 mg/day (1 mg/kg) was prescribed and MMF dose was also increased to 2 …