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A 72-year-old woman presented with a 9-month history of alternating constipation and diarrhoea, with postprandial abdominal pain. She noted constitutional symptoms of weight loss, decreased appetite and night sweats. This occurred on a background of systemic lupus erythematosus (SLE), treated with 200 mg twice daily hydroxychloroquine and 10 mg daily prednisolone. She appeared cachectic with significant muscle wasting. Abdominal examination revealed diffuse tenderness on deep palpation, with no appreciable mass or lymphadenopathy. White cell count was 12.6×109/L (ref range: 4.0–11.0), platelet 580×109/L (ref range: 150–400), C reactive protein 149 mg/L (ref range: <5), erythrocyte sedimentation rate 91 mm/hour (ref range: <20). Tumour markers were within normal range. Rheumatological screening revealed an antinuclear antibody titre of 1:160, while dsDNA (ELISA) (59 IU/mL, ref range: <100) …
Contributors LL and RG: manuscript concept; acquisition of data; drafting of the manuscript and critical revision of the manuscript for important intellectual content. CB: drafting of the manuscript and critical revision of the manuscript for important intellectual content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.