A 68-year-old woman presented with abdominal pain associated with anasarca and hypoalbuminemia of 2.5g/dl, with no significant proteinuria. Computed tomography revealed pleural effusion, pericardial effusion, ascites, and soft tissue edema (fig. 1). Malnutrition, nephropathy, and liver failure were ruled out. 99mTc-labeled human albumin scintigraphy and SPECT/CT were carried out, identifying characteristic findings of protein-losing enteropathy (PLE) (figs. 2 and 3). Immunologic study results were: low complement (C3, 49 IU/ml; C4, 7 IU/ml), antinuclear antibodies (1:5120) with a nucleolar pattern, and anti-double-stranded DNA antibodies (65.9 IU/ml). Systemic lupus erythematosus (SLE) was diagnosed. The patient was treated with diuretics and prednisone at a dose of 1mg/kg/day, resulting in significant symptom improvement.
PLE encompasses a diverse group of disorders associated with excessive serum protein loss, by way of the digestive tract. Diagnosis is made through 99mTc-labeled human albumin scintigraphy or fecal/plasma clearance of alpha 1-antitrypsin. SLE is a rare cause of PLE. Vasculitis, lymphatic ectasia, and the increase in vascular permeability are the mechanisms that explain PLE in SLE. Treatment with steroids and immunosuppressants reverses PLE in a high percentage of cases.
Ethical considerationsThe authors declare that the procedures followed conformed with the ethical standards of the responsible committee on human experimentation, in accordance with the World Medical Association Declaration of Helsinki, and with the patient's informed consent. They also declare that the patient data was handled confidentially and anonymously.
Please cite this article as: González-Regueiro JA, Rico-Rodríguez OC, Valdovinos-Díaz MA. Enteropatía perdedora de proteínas: una manifestación inicial poco habitual de lupus eritematoso sistémico. Revista de Gastroenterología de México. 2019;84:511–512.s