# Lupus mesenteric vasculitis disguised as urticaria with abdominal pain: a case report with 10 months follow-up observation

## TL;DR

A 27-year-old woman with lupus had severe abdominal pain misdiagnosed as urticaria, but later found to have rare mesenteric vasculitis, which improved with aggressive treatment.

## Contribution

This case emphasizes the need for early recognition and aggressive treatment of SLE-related mesenteric vasculitis with long-term follow-up.

## Key findings

- Mesenteric vasculitis in SLE can present with non-specific symptoms like abdominal pain and urticaria.
- High-dose methylprednisolone pulse therapy led to remission in this patient.
- The patient remained stable for 10 months post-treatment, highlighting the importance of extended follow-up.

## Abstract

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease characterized by multi-system involvement, with gastrointestinal manifestations often presenting diagnostic challenges due to their non-specificity. Mesenteric vasculitis, a rare but severe complication of SLE, carries a high misdiagnosis rate and mortality if it cannot be identified promptly. We report a case of a 27-year-old female with SLE presenting initially with atypical abdominal pain and duodenal edema. Due to her history of urticaria, she was initially mistaken for urticaria related abdominal pain. After a correct diagnosis, there was still progress despite conventional glucocorticoid therapy. The patient achieved remission following high-dose methylprednisolone pulse therapy, with sustained stability over 10 months of follow-up. This highlights a focus on long-term efficacy with extended follow-up, which is less common in similar past reports. This case highlights the importance of early recognition of SLE-related mesenteric vasculitis, particularly in patients with non-specific gastrointestinal symptoms, and emphasizes the necessity of aggressive immunosuppressive therapy to improve prognosis.