MD, Professor, Doctor of Medical Sciences, Head of Radiology Department in the University Hospital
Профессор, доктор медицинских наук, заведующий отделом
Медицинский научно-образовательный центр, Отдел лучевой диагностики
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with diverse clinical manifestations, some of which are rare but life-threatening. We present the case of a 34-year-old man with no prior SLE diagnosis who presented with severe hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) and lupus enteritis, later developing hemorrhagic gastritis. Initially, the patient exhibited neurological symptoms, diarrhea, and fever, with laboratory findings revealing profound hyponatremia (103 mmol/L), thrombocytopenia, lymphopenia, and elevated inflammatory markers. SIADH was diagnosed based on high urine sodium (160 mEq/L). Despite initial stabilization, he developed melena, respiratory distress, and septic shock. Imaging revealed enteritis, pneumonia, and Libman-Sacks endocarditis. Serological testing confirmed SLE (ANA 1:5120, anti-dsDNA positivity, hypocomplementemia). Despite aggressive treatment with corticosteroids and antibiotics, the patient succumbed to respiratory failure. Autopsy findings supported widespread SLE-related pathology, including vasculitis and embolic events. This case highlights the diagnostic challenges of SLE presenting with SIADH and hemorrhagic gastroenteritis, emphasizing the need for early recognition and intervention in such rare, rapidly progressive lupus flares.
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with diverse clinical manifestations, some of which are rare but life-threatening. We present the case of a 34-year-old man with no prior SLE diagnosis who presented with severe hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) and lupus enteritis, later developing hemorrhagic gastritis. Initially, the patient exhibited neurological symptoms, diarrhea, and fever, with laboratory findings revealing profound hyponatremia (103 mmol/L), thrombocytopenia, lymphopenia, and elevated inflammatory markers. SIADH was diagnosed based on high urine sodium (160 mEq/L). Despite initial stabilization, he developed melena, respiratory distress, and septic shock. Imaging revealed enteritis, pneumonia, and Libman-Sacks endocarditis. Serological testing confirmed SLE (ANA 1:5120, anti-dsDNA positivity, hypocomplementemia). Despite aggressive treatment with corticosteroids and antibiotics, the patient succumbed to respiratory failure. Autopsy findings supported widespread SLE-related pathology, including vasculitis and embolic events. This case highlights the diagnostic challenges of SLE presenting with SIADH and hemorrhagic gastroenteritis, emphasizing the need for early recognition and intervention in such rare, rapidly progressive lupus flares.