title: Sytemic lupus erythematosus presenting with protein losing enteropathy in a resource limited centre: a case report.
abstract: BACKGROUND
  Systemic lupus erythematosus is a disease which may initially present with varying symptoms, most commonly a photosensitive rash and arthritis. Protein losing enteropathy is a recognized but rare presenting manifestation. Diagnosing protein losing enteropathy in resource limited centres is challenging but possible through the exclusion of other possible causes of hypoalbunaemia.
  
  
  METHODS
  We report a case of protein losing gastroenteropathy secondary to intestinal lymphangiectasia as the initial manifestation of systemic lupus erythematosus in a 57 year old Sri Lankan (South Asian) male patient. The diagnosis was made by the exclusion of other causes of hypoalbuminaemia as the gold standard investigations for protein losing enteropathy were not available at this centre.
  
  
  CONCLUSIONS
  Protein losing enteropathy is a diagnosis of exclusion in resource limited centres in the world. Systemic lupus erythematosus should be considered in the differential diagnosis of protein losing enteropathy. Intestinal lymphangiectasia should also be recognized as a possible pathophysiological mechanism.
authors.affiliation: Wards 45 and 46 A, National Hospital of Sri Lanka, Regent Street, Colombo, Sri Lanka. chamara.ratnayake@gmail.com.
authors.forename: Eranda C
authors.initials: EC
authors.lastname: Ratnayake
authors.forename: Ahamed Aa
authors.initials: AA
authors.lastname: Riyaaz
authors.forename: Bandula C
authors.initials: BC
authors.lastname: Wijesiriwardena