%0 Journal Article
%T Sytemic lupus erythematosus presenting with protein losing enteropathy in a resource limited centre: a case report
%A Eranda C Ratnayake
%A Ahamed AA Riyaaz
%A Bandula C Wijesiriwardena
%J International Archives of Medicine
%D 2012
%I BioMed Central
%R 10.1186/1755-7682-5-1
%X 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.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.Protein-losing enteropathy (PLE) is a condition characterized by hypoalbuminaemia secondary to excessive loss of serum protein from the gastrointestinal tract. Possible mechanisms of intestinal protein loss include partial lymphatic obstruction (intestinal lymphangiectasia), congenital defects in intestinal lymphatics, mucosal ulceration, disordered mucosal cell metabolism and increased central venous pressure [1].PLE is a well recognized but unusual manifestation of systemic lupus erythematosus (SLE) [2,3]. It could rarely be the initial manifestation of the disease [4]. The exact pathogenesis of PLE in SLE remains uncertain. Intestinal or mesenteric vasculitis is a possible mechanism [5] but is rarely found in mucosal biopsies. Other hypothesized mechanisms include intestinal lymphangiectasia, mucosal disruption and increased mucosal capillary permeability due to complement- or cytokine-mediated damage [6,7]A 56-year-old Sri Lankan male patient presented an year ago, with a photosensitive skin rash involving his face and upper trunk and inflammatory type symmetrical polyarthritis involving small and large joints of 3 months duration. On examination there were multiple maculo-papular cutaneous lesions with hyperpigmented borders and hypopigmented central region with scarring distribute
%U http://www.intarchmed.com/content/5/1/1