Pathologic features of gastrointestinal tract lesions in childhood-onset systemic lupus erythematosus: study of 26 patients, with review of the literature.

A review of the gastrointestinal tracts of 26 autopsied cases of childhood-onset systemic lupus erythematosis (SLE) showed the single most common pathologic finding to be chronic nonspecific mucosal infiltration (96%). The most frequent general category was ischemic bowel lesions, attributable to vascular lesions of SLE (60%) or to nonocclusive causes of circulatory insufficiency such as congestive heart failure, uremia, or shock (40%). Complications of ischemic bowel lesions included secondary invasion by opportunistic organisms such as Candida (9 patients), pneumatosis intestinalis (1), and perforation of a gastroesophageal ulcer (1). Colonic ulcers, clearly ischemic in etiology, were noted in 6 patients, none of whom had other bowel lesions resembling those of Crohn's disease or ulcerative colitis. Other relevant findings included ascites (88%), peritoneal inflammation or fibrosis (42%), upper esophageal skeletal muscle fiber atrophy (8%), heterotopic calcification of gastric mucosa (12%), and severe intestinal mucus inspissation (4%). Correlations between the various lesions and clinical manifestations, and possible etiologic and pathogenetic mechanisms of these lesions, are discussed.