Colonoscopy was useful for the diagnosis and the guidance of treatment escalation/de-escalation in a refractory case of lupus colitis

AbstractA Japanese woman in her thirties was diagnosed with systemic lupus erythematosus (SLE) for 15 years and was treated with 17.5 mg/day of prednisolone at the onset of this episode. She was admitted to our hospital due to intermittent abdominal pain, diarrhoea, and bloody faeces lasting for one month. She had no other organ manifestations. A postcontrast computed tomography suggested nonspecific inflammation of the colonic mucosa. A colonoscopy revealed a solitary rectal ulcer, and the biopsied specimen showed erosion and lymphoplasmacytic infiltration in the lamina propria. She was diagnosed with lupus colitis. Her dosage of prednisolone was increased to 30 mg/day, and azathioprine was initiated. Subsequently, her symptoms gradually improved, and she was discharged. However, because abdominal pain and bloody faeces relapsed one week later, she was re-admitted. A repeated colonoscopy revealed that although the initial rectal ulcer improved, there was a new mucous oedema and erosion in the sigmoid col...