Abdalla Elham, Mohymeed Noon, Nail Abdelsalam M A, Tonga Rayan Ali, Alfatih Mohammed, Abdalfdeel Almahie Shaban Mohannad, Eltoum Hassan
Department of Internal Medicine Bahri University Khartoum Sudan.
Department of Internal Medicine Omdurman Islamic University Khartoum Sudan.
Clin Case Rep. 2023 May 10;11(5):e7314. doi: 10.1002/ccr3.7314. eCollection 2023 May.
In low- and middle-income countries, protein-losing enteropathy is a diagnosis of exclusion. SLE should be on the list of differential diagnoses of protein-losing enteropathy, especially if the patient had a long history of GI symptoms and ascites.
Protein-losing enteropathy can rarely be the initial presentation of systemic lupus erythematosus (SLE). Protein-losing enteropathy is a diagnosis of exclusion in low- and middle-income countries. Protein-losing enteropathy in SLE should be in the list of differential diagnosis of unexplained ascites, especially if patient had long history of gastrointestinal symptoms. We present a case of 33 years old male with long standing gastrointestinal symptoms and diarrhea attributed previously to irritable bowel syndrome. Presented with progressive abdominal distension, and diagnosed with ascites. Workup for him showed leucopenia, thrombocytopenia, hypoalbumenemia, elevated inflammatory markers (ESR 30, CRP 6.6), high cholesterol level (306 mg/dL), normal renal profile and normal urine analysis. Ascitic tab pale yellow with SAAG 0.9 and positive for adenosine deaminase (66 u/L) sugesstive for tuberculous peritonitis although quantitative PCR and geneXpert for MBT was negative. Antituberculous treatment was started and his condition deteriorated, immediately antituberculous was withdrawal. Further tests revealed positive serology for ANA (1:320 speckled pattern) with positive anti-RNP/Sm, positive anti-Sm antibodies. Complements level were normal. He started immunosuppressive therapy (prednisolone 10 mg/day, hydroxychloroquine 400 mg/day, azathioprine 100 mg/day). In addition, his condition is improved Diagnosis was made as SLE with Protein-losing enteropathy based on hypoalbumenemia (with exclusion of renal loss of protein), ascites, hypercholesrtolemia and exclusions of other mimics as explained later. As well as positive response to immunosuppressive medications. Our patient diagnosed clinically as SLE with protein-losing enteropathy. Protein-losing enteropathy in SLE is challenging in diagnosis because of its rarity as well as limitations in its diagnostic tests.
在低收入和中等收入国家，蛋白丢失性肠病是一种排除性诊断。系统性红斑狼疮（SLE）应列入蛋白丢失性肠病的鉴别诊断清单中，尤其是当患者有长期胃肠道症状和腹水病史时。
蛋白丢失性肠病很少会是系统性红斑狼疮（SLE）的首发表现。在低收入和中等收入国家，蛋白丢失性肠病是一种排除性诊断。SLE中的蛋白丢失性肠病应列入不明原因腹水的鉴别诊断清单中，尤其是当患者有长期胃肠道症状病史时。我们报告一例33岁男性，有长期胃肠道症状及腹泻，之前归因于肠易激综合征。出现进行性腹胀，诊断为腹水。对其检查显示白细胞减少、血小板减少、低白蛋白血症、炎症标志物升高（血沉30、C反应蛋白6.6）、胆固醇水平高（306mg/dL）、肾功能正常及尿液分析正常。腹水淡黄色，血清腹水白蛋白梯度（SAAG）为0.9，腺苷脱氨酶阳性（66u/L），提示结核性腹膜炎，尽管结核分枝杆菌定量聚合酶链反应（PCR）和GeneXpert检测为阴性。开始抗结核治疗，但其病情恶化，立即停用抗结核药物。进一步检查显示抗核抗体（ANA）血清学阳性（1:320斑点型），抗RNP/Sm阳性，抗Sm抗体阳性。补体水平正常。他开始免疫抑制治疗（泼尼松龙10mg/天、羟氯喹400mg/天、硫唑嘌呤100mg/天）。此外，他的病情有所改善。基于低白蛋白血症（排除肾性蛋白丢失）、腹水、高胆固醇血症以及排除其他类似疾病（如下文所述），诊断为SLE伴蛋白丢失性肠病。以及对免疫抑制药物的阳性反应。我们的患者临床诊断为SLE伴蛋白丢失性肠病。SLE中的蛋白丢失性肠病诊断具有挑战性，因为其罕见性以及诊断测试的局限性。
