Systemic lupus erythematosus complicated with gastric cancer in an old man: A case report and literature review

A 63‐year‐old man presented with a 4‐month history of unintentional decreased appetite, weight loss, and fatigue, but no fever, abdominal pain, or other discomfort symptoms. Endoscopic examination revealed an irregular 5‐cm mucosal lesion on the gastric flexure. The pathology examination revealed poorly differentiated adenocarcinoma (mainly signet ring cell carcinoma). Ultrasound endoscopy indicated that the lesion had broken through the muscle layer to the serosal layer, but the serosal layer was still continuous and no enlarged lymph nodes were seen in the abdominal cavity. No lymph nodes or distant metastases were observed on chest‐abdomen enhanced computed tomography. No fever, rash, joint pain, baldness, photosensitization, canker sores, or ulceration of the genitals developed during the disease. One of the patient's brothers had died of GC. On physical examination, the patient was lean with a body mass index of 23 kg/m. No bleeding spots were observed on the skin or mucous. No abnormality was detected in the cardiopulmonary examination. We observed no pressure pain or lumps in the abdomen, liver, or spleen below the costal space and no edema in the lower limbs. On biochemical test, urinary protein was negative, and blood examination revealed thrombocytopenia and hypoalbuminemia. D‐dimer and erythrocyte sedimentation rate were slightly elevated, and complement C3 and C4 were markedly decreased. Immunological tests showed positive results for anti‐nuclear antibodies, double‐stranded DNA antibodies, and anti‐ribosomal antibody. Immunoglobulin G, high‐sensitivity C‐reactive protein, anticardiolipin, and anti‐β‐glycoprotein I antibody showed negative results. Bone marrow smear showed a ratio of granulocytic precursors to erythroid precursor of 2.37; the count of megakaryocytes was 57, with 49 out of 50 granulocytes and one out of 50 naked megakaryocytes; and the platelets were relatively rare. Ultrasonographic scanning of the lower limbs showed that intermuscular venous thromboembolism had occurred. SLE, GC, hypoalbuminemia, and thromboembolism of the double lower limbs and malnutrition were diagnosed based on those findings. With the patient hospitalized for 15 days, multidisciplinary consultation was organized. The surgeon and the oncologist offered the following opinion: The diagnosis of gastric carcinoma was definite, as there was no distant metastasis or local invasion. Surgical resection would be preferred; however, the patient was complicated with SLE and the platelet count was too low for surgery to be carried out. If the platelet count could be elevated to >50 × E/L, and the patient wanted surgical treatment, surgery might be considered. The immunologist offered the following opinion: The diagnosis of SLE and immune thrombocytopenic purpura should be considered. Thrombocytopenia may be associated with connective tissue disease. The geriatrician offered the following opinion: According to the guidelines for the diagnosis and treatment for comorbidities, surgical resection would be preferred. We insisted on surgical treatment after full communication with the patient. Preoperative preparation was administered using 10 g/d of the human immunoglobulin for 2 days, 20 g/d of the human