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GI hemorrhage may be secondary to NSAIDs (stomach), vasculitis of the GI tract
(small intestines), or thrombocytopenia. The patient may develop massive bleeding
leading to shock. If bleeding from a gastric ulcer is suspected, endoscopy can confirm
the diagnosis. Therapy for a bleeding gastric ulcer includes volume replacement, IV
proton pump inhibitors, and possibly IV octreotide (1 μg/kg, maximum 100 μg,
followed by an infusion of 1 to 2 μg/kg/hr [maximum 50 μg/hr]) (see section on Upper
GI bleeding, Chapter 33 Gastrointestinal Bleeding ).
If active Bleeding due to vasculitis is suspected, celiac axis angiography or
endoscopy with deep intestinal biopsies is required for confirmation. GI vasculitis is
rare in pediatric lupus, but when it develops, it most commonly occurs in the setting of
chronically active disease.
Cardiac Complications. Pericarditis and myocarditis are two of the important cardiac
complications of SLE that may require emergency care (see Chapter 86 Cardiac
Emergencies ). Pericarditis without significant hemodynamic effects may be managed
with NSAIDs or corticosteroids, whereas larger effusions may require drainage.
Myocarditis is treated with corticosteroids and bed rest with monitoring.
Raynaud Phenomenon. Raynaud phenomenon (RP) is characterized by triphasic color
changes of the extremities upon exposure to cold. These color changes proceed from
cyanosis to blanching due to microcirculatory compromise, and resolve with erythema
caused by reactive hyperemia. Severe episodes of RP may cause excruciating pain in
the extremities, or even digital ulceration and autoamputation. Poor circulation impairs
wound healing and clearing of infections, so patients with paronychia or digital
cellulitis in the setting of acral ischemia may require admission for IV antibiotics.
Prophylactic techniques to improve digital circulation (avoidance of cold exposure,
biofeedback) are the cornerstones of treatment of RP. Calcium-channel blockers (e.g.,
slow-release nifedipine) may decrease the frequency and severity of attacks, whereas
oral (e.g., prazosin, sildenafil) and topical (e.g., nitroglycerine) vasodilators or medical
or surgical sympathetic blockade may be necessary during severe episodes. Cases of
impending gangrene may also be treated with prostacyclin analogs.
Hypertension. Hypertension may be a result of effects of SLE on systemic vasculature,
the effects of SLE renal involvement, or steroid therapy.

Headaches. Up to 80% of patients with SLE develop headaches, many migrainous, and
they may experience acute, incapacitating exacerbations. Meningitis (both septic and
aseptic), hypertension, and pseudotumor cerebri (idiopathic intracranial hypertension)
must be ruled out in children with severe headaches. They should have a complete
neurologic evaluation and examination of the CSF once a space-occupying lesion has
been excluded. If the headache is accompanied by blurring or loss of vision, an