"When both ends meet" a case report of Crohn's disease in a patient with systemic lupus erythematosus
Background: Inflammatory bowel disease (IBD) is an uncommon autoimmune condition affecting Filipinos. Its association with systemic lupus erythematosus (SLE) is even more unusual. The immunological background of both diseases is thought to explain the mechanism of this rare association.1 Objective: To present an unusual case of lower gastrointestinal bleeding in a patient with SLE Setting: A tertiary training hospital in Cavite, Philippines Case Summary: A 29 year old Filipina with 11 years history of SLE developed a recent flare of lupus nephritis. She also presented with bloody diarrhea and anemia. Bleeding was initially attributed to thrombocytopenia or to platelet dysfunction due to renal insufficiency. Colonoscopy revealed superficial ulcerations on the terminal ileum, asymmetric granulomatous/cobblestone mucosa at various levels where punctuate ulcerations were actively bleeding which are consistent with Crohn's disease. The patient was treated with mesalazine and methylprednisolone pulse with note of resolution of lower gastrointestinal bleeding. Significance: This report highlights the importance of considering a wide range of differentials in dealing with complications of systemic lupus erythematosus. Further, it illustrates the supreme importance of endoscopic evaluation for patients with gastrointestinal bleeding.