title: Protein-losing enteropathy as initial manifestation of systemic lupus erythematosus.
abstract: Protein-losing enteropathy is a rare manifestation of systemic lupus erythematosus. We report the case of an 18-year-old woman that presented initially with diarrhoea and anasarca. During evaluation, there was low serum albumin of 1.6 g/dl (3.5-5.2 g/dl) and a positive antinuclear antibody test (1:2560). Anti-Sm antibodies (ELISA) were positive in addition to low serum C3 of 35 mg/dl. A scintigraphy using 99mTc-labelled albumin was positive for abdominal protein loss. A diagnosis of systemic lupus erythematosus related protein-losing enteropathy was made. She was started on prednisolone 40 mg/day without amelioration; a month later, azathioprine (100 mg/day) was added, leading to normalization of serum albumin and resolution of symptoms within 4 months. After 1.5 years, the patient developed a 2.9 g 24-h proteinuria while still in remission of the protein-losing enteropathy, receiving 5 mg prednisone and 100 mg azathioprine daily.
authors: Gastroenterology Division, Hospital Universitário Walter Cantídio of the Universidade Federal do Ceará, Fortaleza, Brazil. arocha@ufc.br
authors: F O A A
authors: FO
authors: Carneiro
authors: L R
authors: LR
authors: Sampaio
authors: L A R
authors: LA
authors: Brandão
authors: L L B C
authors: LL
authors: Braga
authors: F A C
authors: FA
authors: Rocha
mesh_terms: D000293:Adolescent; D000974:Antibodies, Antinuclear / Q000097:blood; D001379:Azathioprine / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D003176:Complement C3 / Q000032:analysis; D003967:Diarrhea / Q000209:etiology; D004359:Drug Therapy, Combination; D004487:Edema / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D008181:Lupus Nephritis / Q000209:etiology; D011239:Prednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011504:Protein-Losing Enteropathies / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D011507:Proteinuria / Q000209:etiology; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000974:Antibodies, Antinuclear; D015415:Biomarkers; D003176:Complement C3; D007166:Immunosuppressive Agents; D012709:Serum Albumin; D011239:Prednisolone; D001379:Azathioprine; D011241:Prednisone