School of Medicine Publications
Document Type
Article
Publication Date
7-12-2026
Abstract
Gastrointestinal perforation in systemic lupus erythematosus (SLE) is uncommon but potentially fatal, and attribution is clinically consequential because perforation may reflect lupus enteritis with mesenteric vasculitis, infection, diverticular or stercoral disease, malignancy, inflammatory bowel disease (IBD), medication-related injury, or a combination of mechanisms. Corticosteroid-associated perforation is therefore best treated as a diagnosis of exclusion rather than as an isolated novel observation. We report a 62-year-old woman with SLE who developed sudden severe right-sided abdominal pain, nausea, vomiting, leukocytosis, lactic acidosis, and radiographic pneumoperitoneum while tapering prednisone from 60 mg/day to 10 mg/day over three months, with 10 mg/day documented at presentation in the available medication history. Computed tomography demonstrated free intraperitoneal air without radiologic diverticulitis or a clear alternative source. Emergent robotic-assisted laparoscopy was converted to open surgery because of extensive purulent contamination. Approximately 1.5 L of pus was evacuated, and a solitary mid-transverse colon perforation was treated with segmental colectomy and primary anastomosis. Gross pathology showed an irregular ulcer with a transmural defect and no mass or diverticulum. Histopathology demonstrated a full-thickness perforated ulcer with acute-on-chronic inflammation and granulation tissue, without vasculitis, thrombosis, ischemic necrosis, granulomas, IBD, or malignancy. The postoperative course was uncomplicated, with the return of bowel function by postoperative day 4 and discharge on day 6. This case is unusual because SLE-associated intestinal perforation is more commonly described in the context of active lupus mesenteric vasculitis or other identifiable etiologies. The report emphasizes a structured exclusion-based diagnostic approach, early source control, and postoperative reassessment of glucocorticoid exposure and steroid-sparing therapy
Recommended Citation
Lawal, R. A., Malaga, N., Asif, N., Bello, F., & Yang, J. (2026). Isolated Transverse Colon Perforation During Corticosteroid Tapering in Quiescent Systemic Lupus Erythematosus: A Histopathology-Supported Diagnosis of Exclusion. Cureus, 18(7). https://doi.org/10.7759/cureus.112550
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Publication Title
Cureus
DOI
10.7759/cureus.112550
Academic Level
faculty
Mentor/PI Department
Internal Medicine
Comments
© Copyright 2026 Lawal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.