• Biki Kumar Sah, Shipra Chaudhary, Ashhrik Pahari, Aasha Ghimire, Rajan Kumar Sah, Abhishek Kumar Sah, Neelam Kumari, Yaswant Kumar Jaiswal, and Vivek Kumar Sah.
• Department of Pediatrics and Adolescent Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
• Medicine (Baltimore). 2022 Dec 16; 101 (50): e32201e32201.

IntroductionDue to heterogeneity in the organs involved and a variety of influencing factors, a wide range of clinical manifestations are possible in systemic lupus erythematosus (SLE). In our knowledge, a combination of leg ulcer and dysentery as presenting symptoms of SLE has never been reported previously.Patient ConcernsA 13-year-old female child presented with a chronic wound over right medial malleolus for 6 months, and passing of watery stool, later mixed with blood, for 4 days. On examination, she had a fever of 38.5°C. Lab reports revealed anemia, thrombocytopenia, proteinuria, and features of urinary tract infection. Renal biopsy showed membranous glomerulonephropathy. She was positive for antinuclear antibodies (ANA) and antidouble stranded DNA (anti-dsDNA). Immunofluorescence revealed reduced C4 and C3 levels. Abdominal ultrasound showed symmetrical circumscribed thickening, and edematous cecum and ascending colon.DiagnosisThe patient was diagnosed with SLE based on the Systemic Lupus International Collaborating Clinics classification criteria.InterventionsThe patient was treated with prednisolone, hydroxychloroquine, metronidazole, ciprofloxacin, trypsin-chymotrypsin, zinc, calcium, and calcitriol tablets.OutcomesFever subsided within 3 days of treatment. Gastrointestinal symptoms subsided within 1 week of treatment. On 31 day of treatment, the wound had been reduced and showed features of healing.ConclusionDysentery and leg ulcers can be the manifestations of SLE. Therefore, SLE should also be considered when a patient presents with such symptoms. Any suspicion of infection in SLE should be treated aggressively with antibiotics.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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