Ischemic duodenal injury due to systemic lupus erythematosus: A case report

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving multiple organ systems. Lupus enteritis is a rare but potentially life-threatening gastrointestinal manifestation characterized by immune complex-mediated inflammation that may cause edema, ischemia, or intestinal perforation. Because abdominal symptoms often overlap with those of infection or drug toxicity, an accurate diagnosis requires a high index of suspicion supported by characteristic radiologic findings. CASE SUMMARY: A 47-year-old female with a known history of SLE and membranous glomerulonephritis presented with acute epigastric pain. Contrast-enhanced computed tomography revealed venous-type ischemia involving the second portion of the duodenum and proximal jejunum. Despite intensive medical management, progressive ischemic changes necessitated surgical resection and duodenojejunostomy. Postoperatively, the patient developed pancreatitis and biliary obstruction at the ampulla of Vater, requiring coordinated multidisciplinary care, including rheumatologic evaluation for disease flares, radiology-guided percutaneous transhepatic biliary drainage, internal stent placement, and pathological confirmation of small-vessel vasculitis. Both complications resolved after intervention. Duodenal involvement in lupus enteritis is exceptionally rare, and cases requiring surgical intervention are even rarer. Consequently, only a few cases have been reported. CONCLUSION: Prompt recognition and multidisciplinary management are essential for favorable outcomes in patients with severe lupus enteritis and duodenal involvement.