CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Belimumab-induced remission in refractory lupus mesenteric vasculitis: a case report with 49-month follow-up
Wen-jia Gao 1
Qi-feng Zang 2
Yan Xu 1
Yinshan Zang 3
1. Jiangsu Province Hospital, Suqian, China
2. Bengbu Medical University, Bengbu, China
3. Jiangsu Province Hospital suqian, Suqian, China
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Abstract
Background: Lupus mesenteric vasculitis (LMV) is a rare but life-threatening gastrointestinal complication of systemic lupus erythematosus (SLE). Refractory cases pose significant therapeutic challenges due to limited treatment options and cumulative toxicity from long-term immunosuppressant therapy. Case presentation: A 46-year-old woman with SLE presented with recurrent abdominal pain, diarrhea, and malar rash over a 1-year period. Despite receiving standard immunosuppressive therapies — including glucocorticoids (GCs), cyclophosphamide, mycophenolate mofetil, and tacrolimus — she experienced multiple relapses of LMV between 2015 and 2020, confirmed by abdominal computed tomography showing bowel wall thickening and the characteristic "target sign." In September 2020, belimumab (600 mg intravenous every 4 weeks) was initiated alongside a reduced-dose GC regimen. Over a 49-month treatment period (34 doses), the patient achieved sustained remission, with complete resolution of abdominal symptoms, normalization of computed tomography findings, stable Systemic Lupus Erythematosus Disease Activity Index scores (0–4), decreasing anti-double-stranded DNA titers (<20 IU/mL), and rising serum complement C3 levels (>0.6 g/L). GC dosage was successfully tapered to 2.5 mg/day without disease relapse. Conclusions: This case demonstrates belimumab's efficacy in achieving the longest documented remission (49 months) in refractory LMV, highlighting its potential as a first-line biologic for steroid-dependent gastrointestinal vasculitis.
Summary
Keywords
belimumab, Biologicagents, case report, Glucocorticoid-sparing effect, Mesenteric vasculitis, systemic lupus erythematosus
Received
17 August 2025
Accepted
18 February 2026
Copyright
© 2026 Gao, Zang, Xu and Zang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yinshan Zang
Disclaimer
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