Systemic lupus erythematosus complicated with protein-losing enteropathy: a case report and review of the published works.
A 45-year-old man was referred to our hospital with a history of multiple erythematous skin lesions of several months' duration. Blood examination revealed extreme hypoproteinemia and hypoalbuminemia, as well as the presence of antinuclear antibodies. A skin biopsy specimen showed liquefaction degeneration at the dermoepidermal junction and dense lymphocyte and neutrophil infiltration around the vessels and appendages in the upper and middle dermis. Chest X-ray and computed tomography showed a pleural effusion and thoracic paracentesis revealed a mononuclear cell-dominant cell infiltration, suggestive of serositis. Technetium-99m ((99m)Tc)-labeled human serum albumin scintigraphy and α(1)-antitrypsin clearance revealed protein leakage along the digestive tracts from the stomach to the jejunum. From the above findings, the patient was diagnosed with systemic lupus erythematosus (SLE) complicated by protein-losing enteropathy (PLE). Treatment with oral prednisolone significantly improved his clinical symptoms and hypoalbuminemia. This case highlighted the utility of (99m)Tc-labeled human serum albumin scintigraphy and α(1)-antitrypsin clearance in the diagnosis of PLE. We also present a published work review on PLE associated with connective tissue disease revealing a relatively higher prevalence in patients of Asian ethnicity, including Japanese.
Department of Dermatology, Graduate School of Medicine, University of Ryukyus, Okinawa, Japan.
Ryoko
R
Awazawa
Yu-ichi
Y
Yamamoto
Yoshiko
Y
Mine
Ikumi
I
Nakamura
Kazuto
K
Kishimoto
Fukunori
F
Kinjyo
Keisuke
K
Hagiwara
Jiro
J
Fujita
Hiroshi
H
Uezato
Kenzo
K
Takahashi
D044466:Asian People; D006801:Humans; D007564:Japan; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D011504:Protein-Losing Enteropathies / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D000515:alpha 1-Antitrypsin / Q000378:metabolism
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D000515:alpha 1-Antitrypsin; D011239:Prednisolone