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Main text A 31-year-old female was admitted to our institution with abdominal discomfort and right lower quadrant pain started 1 month ago. A slight defense was observed during physical examination, but no sign of rebound was detected. Her rectal examination and bowel sounds were within the normal limits. In her detailed history, she described systemic lupus erythematosus (SLE) anamnesis managed with a maintenance therapy of low-dose corticosteroids. Complete blood count, laboratory test, and stool sample analysis were within the normal limits, except for mildly decreased albumin levels (3.61 g/dL), increased C-reactive protein levels (18.4 mg/L), and elevated anti-double-stranded DNA antibody levels. Ultrasound examination revealed small bowel wall edema, splenomegaly, and diffuse ascites in the abdomen. Upon detection of small bower wall edema and given the history SLE, the patient underwent computed tomography angiography (CTA) with a suspected diagnosis of mesenteric ischemia due to the vasculitic course of the disease. The visceral branches of the abdominal aorta and mesenteric and portal venous vessels were found to be intact; however, diffuse small bowel edema and mucosal enhancement giving a “target” sign were observed on CTA (Figure 1a, b). In addition to small bowel edema, considerable ascites was seen in the abdominal cavity (Figure 1a, b). Considering the history, laboratory test, and CTA findings, a diagnosis of lupus-associated intestinal vasculitis (LAIV) was made. The patient was referred to the internal medicine department and high-dose methylprednisolone (2 mg/kg body weight/day) was started, with the dose gradually tapered over a 2-week period. After medical treatment, her symptoms resolved progressively and control ultrasonographic evaluation showed absence of small bowel edema and ascites.

Computed tomography angiography (CTA) findings of lupus-associated intestinal vasculitis