title: Protein-losing enteropathy associated with refractory systemic lupus erythematosus with a good response to rituximab.
abstract: A case is presented of a protein-losing enteropathy (PLE) as the initial manifestation of systemic lupus erythematosus (SLE) in a 17 year-old female patient, who presented with ascites, edema and hypoalbuminemia. The diagnosis of SLE was based on the presence of: malar rash, oral ulcers, thrombocytopenia, antinuclear antibodies, IgM anticardiolipin antibody, and lupus anticoagulant. Renal and liver diseases were ruled out. The PLE diagnosis was confirmed with fecal alpha 1-antitrypsin clearance. The PLE was refractory to different lines of immunosuppressive agents like glucocorticoids, cyclophosphamide, azathioprine, and cyclosporine, showing a satisfactory and sustained response with rituximab, allowing steroid sparing and long term remission.
authors.affiliation: Servicio de Reumatología, Hospital Interzonal General de Agudos (HIGA) General San Martín, La Plata, Buenos Aires, Argentina. Electronic address: pierina95@hotmail.com.
authors.forename: Pierina
authors.initials: P
authors.lastname: Sansinanea
authors.affiliation: Servicio de Gastroenterología, Hospital Interzonal General de Agudos (HIGA) General San Martín, La Plata, Buenos Aires, Argentina.
authors.forename: Sebastián Augusto
authors.initials: SA
authors.lastname: Carrica
authors.affiliation: Servicio de Reumatología, Hospital Interzonal General de Agudos (HIGA) General San Martín, La Plata, Buenos Aires, Argentina.
authors.forename: Josefina
authors.initials: J
authors.lastname: Marcos
authors.affiliation: Servicio de Reumatología, Hospital Interzonal General de Agudos (HIGA) General San Martín, La Plata, Buenos Aires, Argentina.
authors.forename: Mercedes Argentina
authors.initials: MA
authors.lastname: García
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011504:Protein-Losing Enteropathies / Q000188:drug therapy / Q000209:etiology*; D012008:Recurrence; D000069283:Rituximab / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D000069283:Rituximab
keywords: Enteropatía perdedora de proteínas; Lupus eritematoso sistémico; Protein-losing enteropathy; Refractario; Refractory; Rituximab; Systemic lupus erythematosus