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Colonoscopy was useful for the diagnosis and the guidance of treatment escalation/de-escalation in a refractory case of lupus colitis

Abstract A Japanese woman in her thirties was diagnosed with systemic lupus erythematosus (SLE) for 15 years and was treated with 17.5 mg/day of prednisolone at the onset of this episode. She was admitted to our hospital due to intermittent abdominal pain, diarrhoea, and bloody faeces lasting for one month. She had no other organ manifestations. A postcontrast computed tomography suggested nonspecific inflammation of the colonic mucosa. A colonoscopy revealed a solitary rectal ulcer, and the biopsied specimen showed erosion and lymphoplasmacytic infiltration in the lamina propria. She was diagnosed with lupus colitis. Her dosage of prednisolone was increased to 30 mg/day, and azathioprine was initiated. Subsequently, her symptoms gradually improved, and she was discharged. However, because abdominal pain and bloody faeces relapsed one week later, she was re-admitted. A repeated colonoscopy revealed that although the initial rectal ulcer improved, there was a new mucous oedema and erosion in the sigmoid colon. She received pulse methylprednisolone, and prednisolone was increased to 50 mg/day. Subsequently, her symptoms and colonoscopic findings ameliorated, and she was discharged. Infectious colitis and inflammatory bowel diseases were ruled out based on multiple biopsies and her clinical course. Amelioration by immunosuppressive treatment suggested that the colitis was SLE-related. In the literature, rare cases of SLE-related colon ulcers were reported. Lupus colitis sometimes presents without other disease activity, and sometimes results in perforation and death. Colonoscopy was the most useful examination for the diagnosis and the guidance of treatment escalation/de-escalation in this refractory case of lupus colitis.