• Brittany L Adler, Homa Timlin, and Julius Birnbaum.
• Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD.
• Medicine (Baltimore). 2019 Jul 1; 98 (28): e16178.

IntroductionIntestinal pseudo-obstruction (IPO) is a rare and life-threatening complication of lupus.Patient ConcernsA patient with long-standing lupus developed recurrent abdominal pain and distension as well as nausea and emesis.DiagnosisImaging showed dilated small bowel loops with air-fluid levels and bowel wall thickening. She also had bilateral hydronephrosis.InterventionsShe was given high-doses of intravenous steroids and cyclophosphamide.OutcomesHer symptoms resolved within a week of starting immunosuppression. She was eventually transitioned to mycophenolate mofetil. She remained in remission and immunosuppression was successfully stopped after 1 year.ConclusionsIntestinal pseudo-obstruction is a rare complication of lupus that is often seen in association with ureterohydronephrosis and interstitial cystitis. This clinical syndrome is thought to be because of smooth muscle dysmotility of the gastrointestinal and genitourinary tracts, although the exact mechanism of dysmotility remains unknown. This condition is often responsive to immunosuppression if recognized and treated promptly.

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