Missing the forest for the trees

In summary, a multisystem disease such as SLE requires a comprehensive history, physical exam, and review of systems to establish a correct diagnosis. In our case, an extensive evaluation was necessary to exclude other etiologies of abdominal pain and systemic illness, particularly as infectious and neoplastic conditions occur far more often than lupus enteritis in the general population. However, profound laboratory abnormalities may have preoccupied the attention of treating physicians, leading them to overlook less obvious but important historical and physical findings suggestive of SLE. The cohesively abnormal "forest" may thus have been obscured by erratically abnormal individual "trees". Gastrointestinal symptoms may be under-recognized in SLE. When these result for lupus enteritis, timely recognition may be lifesaving.