systemic lupus erythematosus ( sle ) is an autoimmune disease that may involve multiple organs . herein , we report a case of fatal gastrointestinal vasculitis as a rare presentation of systemic lupus erythematosus in a 34-year - old woman . a 34-year - old woman was admitted to our hospital because of progressive lower abdominal pain for duration of two weeks . she developed a few episodes of non - bloody , loose stool along with constant lower abdominal pain . she did not experience any fever , anorexia , or weight loss.on physical examination she was conscious , mildly pale , and afebrile with pulse rate : 100 beats / min , blood pressure : 120/80 mmhg , respiratory rate : 14/min , mild diffuse abdominal tenderness , and mild abdominal distension along with shifting dullness . laboratory data showed white blood count ( wbc):4700/mm ( neutrophil : 80% , lymphocyte : 9% , monocyte : 1% , eosinophil : 10% ) , hemoglobin : 12.8 g / dl , platelet count : 84,000/mm , esr : 11 mm , crp : 24 mg / dl , ldh : 610 iu / l ( nl<460 ) , ast : 20 iu / l , alt : 13 iu / l , alp : 165 iu / l , total bilirubin : 0.3 g / dl , direct bilirubin : 0.1 g / dl , pt : 12 sec , inr : 1 , ptt : 25 sec , total protein : 6.4 g / dl , albumin : 3.2 g / dl , bun : 23 mg / dl , creatinin : 0.7 ng / ml . peripheral blood smear showed low platelet , as well as hypochromia , anisocytosis , and microcytosis in red blood cells . a diagnostic paracentesis was done , which showed : total protein : 5.1 g / dl , albumin : 2.6 g / dl , wbc : 160/mm with 55% lymphocytes , rbc : 3700/mm .the serum - ascites albumin gradient ( saag ) was 0.5 . bacterial evaluation , acid fast staining , and cultures of the fluid were all negative . abdominopelvic computed tomography showed diffused wall thickening in the colon along with thickening of a loop in the small intestine at the left upper quadrant . marked ascites and small left pleural effusion were also seen but no evidence of vascular thrombosis was detected . platelet count rapidly dropped to 20,000 during the next few days but reticulocyte count , d - dimer and coomb s test were normal . the patient remained in good condition and her diarrhea and abdominal pain improved with supportive treatment . five days after taking biopsy samples , the patient s condition deteriorated as she complained of vomiting and diarrhea , yet again . at the same day she underwent another abdominopelvic computed tomography that showed wall thickening of the colon and target sign in the small intestine . upper pole of the left kidney showed heterogeneous enhancement of suspected ischemic changes but no evidence of vascular thrombosis was detected again ( figure 1 ) . abdominal and pelvic tomogram with intravenous and oral contrast showed target sign ( narrow arrows ) and ischemic changes in left kidney ( thick arrows ) . initial investigations for infectious agents including strongyloides stercoralis and neoplasms such as lymphoma were negative . however , antinuclear antibody was elevated to 100 ( nl<10 eu ) . intravenous hydrocortisone 300 mg / day was started immediately and anti ds - dna and complements ( c3 , c4 , ch50 ) were requested to be tested . despite the use of high dose intravenous steroid therapy , the patient s symptoms did not improve . the patient underwent diagnostic laparoscopy after 3 days of corticosteroid therapy because of the new changes in her condition . a few minutes after the procedure , abundant pinkish discharge was noted via the endotracheal tube and the patient also developed hypoxemia and tachycardia . on examination she had bilateral diffuse rales and ronchi along with a distended abdomen . her death was due to disseminated intravascular coagulation ( dic ) and subsequent respiratory failure . laboratory data later showed high titer of anti ds - dna [ 150 ( nl<35 iu / ml ) ] and low complement levels . gi sample biopsies through laparoscopy and after death ( open laparotomy ) from intestine did not show any histological abnormality . sle enteritis is one of the most common causes of abdominal pain in sle . some laboratory data used to detect sle activity such as anti phospholipid antibody ( apl ) , do not correlate with lupus enteritis except leucopenia . computed tomography can show and monitor pathological abnormalities in the abdomen . in one study target sign was reported in 90% of patients with sle who complained of acute abdominal pain . in all cases , bowel wall thickening was circumferential and symmetric and the most common sites of involvement were the jejunum and ileum . double halo or target sign , can be seen due to submucosaledema of the small bowel . in our case diffuse wall thickening was seen in the colon and rectum in early phase , which extended to the small intestine with target sign view . we performed diagnostic laparoscopy due to the rapid deterioration of her condition to detect any complications ; however no macroscopic or microscopic abnormalities were found in the bowel and finally she died as a result of dic . although complications of diagnostic laparoscopy are rare , we can not rule out the positive pressure effects on small vessels through gas insufflations . small vessels are involved during gi vasculitis and even minimal positive pressure might lead to reduce visceral perfusions in this setting . we could not find the reason for the patient 's rapid deterioration and death after diagnostic laparoscopy . clinicians can prevent morbidity and mortality of sle related gi vasculitis if they can recognize and treat it as early as possible . abdominal computed tomography is a useful tool for detecting some abnormalities in abdominal pain of patients with sle .