Objective:

To report a rare case of simultaneous lupus enteritis and ureteritis in a pediatric patient and highlight the diagnostic challenges encountered.

Approach:

• Case Presentation: A 16-year-old girl with a history of transient ptosis and positive ANA/dsDNA presented with abdominal pain, fever, and dysuria. Initial CT showed bilateral hydroureteronephrosis, and repeat CECT revealed bowel wall enhancement, splenic infarction, and ureteral wall enhancement. The patient's condition deteriorated despite antibiotic therapy.
• Key Findings: Ureteral wall enhancement on CECT can indicate primary lupus ureteritis, which is crucial for accurate diagnosis. The patient exhibited a 'visceral vasculitis storm' involving the bowel, ureters, and spleen.
• Interpretation: Recognizing concurrent visceral vasculitis manifestations is essential for timely intervention.
• Limitations: The rarity of lupus ureteritis limits generalizability of findings. Potential misdiagnosis may occur due to overlapping symptoms with conditions such as lupus cystitis.
• Conclusion: This case highlights the diagnostic complexity of simultaneous lupus enteritis and ureteritis.

Key Findings:

• Ureteral wall enhancement on CECT can indicate primary lupus ureteritis.
• The patient exhibited a 'visceral vasculitis storm' involving the bowel, ureters, and spleen.
• The case emphasizes the importance of distinguishing between primary ureteritis and secondary mechanical compression.

Interpretation:

Recognizing concurrent visceral vasculitis manifestations is crucial for timely intervention and preventing irreversible organ damage.

Limitations:

• The rarity of lupus ureteritis limits generalizability of findings.
• Potential misdiagnosis due to overlapping symptoms with other conditions.

Conclusion:

This case underscores the diagnostic complexity of simultaneous lupus enteritis and ureteritis and the importance of aggressive immunosuppressive therapy.