{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T06:18:24Z","timestamp":1783577904460,"version":"3.55.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Systemic Lupus Erythematosus (SLE) is a multi-system autoimmune disease. Although lupus enteritis is a recognized manifestation of mesenteric vasculitis, lupus ureteritis is rare. The simultaneous occurrence of both, termed a \u201cvisceral vasculitis storm,\u201d poses a significant diagnostic challenge. Clinicians often struggle to differentiate primary ureteritis from secondary mechanical compression caused by intestinal edema (the \u201cmonistic\u201d view).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 16-year-old girl with a history of transient ptosis and positive ANA\/dsDNA results 4 months prior to the current presentation, presented with abdominal pain, fever, and transient dysuria. Initial outpatient CT revealed bilateral hydroureteronephrosis. During hospitalization, the patient's condition deteriorated despite antibiotic therapy. A repeat contrast-enhanced CT (CECT) demonstrated the classic \u201ctarget sign\u201d in the bowel wall, splenic infarction, and crucially, distinct ureteral wall enhancement. Laboratory findings showed a \u201chigh CRP\/low PCT\u201d dissociation and a markedly elevated D-Dimer (13.74 \u03bcg\/mL). The diagnosis was revised to SLE with diffuse visceral vasculitis. The patient responded rapidly to methylprednisolone pulse therapy and IVIG, followed by maintenance therapy with Cyclophosphamide and the dual BLyS\/APRIL inhibitor Telitacicept.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights that ureteral wall enhancement on CECT can serve as a potentially useful radiologic clue for primary lupus ureteritis. Recognizing the \u201cvisceral vasculitis storm\u201d is essential to avoid the pitfalls of diagnostic monism and to initiate aggressive immunosuppressive therapy promptly to prevent irreversible organ damage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1882588","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:36:31Z","timestamp":1783575391000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A \u201cvisceral vasculitis storm\u201d in Systemic Lupus Erythematosus: simultaneous enteritis, ureteritis, and splenic infarction in a pediatric patient"],"prefix":"10.3389","volume":"13","author":[{"given":"Xia","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology, Suining Central Hospital","place":["Suining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Suining Central Hospital","place":["Suining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"He","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Suining Central Hospital","place":["Suining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2110","DOI":"10.1056\/NEJMra1100359","article-title":"Systemic lupus erythematosus","volume":"365","author":"Tsokos","year":"2011","journal-title":"N Engl J Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2677","DOI":"10.1002\/art.34473","article-title":"Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus","volume":"64","author":"Petri","year":"2012","journal-title":"Arthritis Rheum."},{"key":"B3","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1136\/annrheumdis-2019-215089","article-title":"2019 update of the EULAR recommendations for the management of systemic lupus erythematosus","volume":"78","author":"Fanouriakis","year":"2019","journal-title":"Ann Rheum Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/1750-1172-8-67","article-title":"Lupus enteritis: from clinical findings to therapeutic management","volume":"8","author":"Janssens","year":"2013","journal-title":"Orphanet J Rare Dis."},{"key":"B5","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1097\/RHU.0b013e318284794e","article-title":"Lupus enteritis: an uncommon manifestation of systemic lupus erythematosus","volume":"19","author":"Smith","year":"2013","journal-title":"J Clin Rheumatol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.12998\/wjcc.v7.i11.1315","article-title":"Lupus enteritis as the only active manifestation of systemic lupus erythematosus: a case report","volume":"7","author":"Gonzalez","year":"2019","journal-title":"World J Clin Cases."},{"key":"B7","doi-asserted-by":"publisher","first-page":"255","DOI":"10.5114\/reum.2018.77978","article-title":"Systemic lupus erythematosus of the urinary tract: focus on lupus cystitis","volume":"56","author":"Liberski","year":"2018","journal-title":"Reumatologia."},{"key":"B8","first-page":"208","article-title":"Involvement of the urinary bladder in systemic lupus erythematosus. 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