Protein-Losing Enteropathy as the First Presentation of Systemic Lupus Erythematosus in a Resource-Limited Setting in Sri Lanka: A Case Report

    March 2023 in “ Curēus ”
    Ramanathan Ramesh, Navaneethakrishnan Suganthan, G. Selvaratnam, Uthayakumar Anushanth, Vadivel Vijitharan
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    TLDR A woman in Sri Lanka was diagnosed with lupus after presenting with protein loss from the gut and other symptoms.
    A 38-year-old Sri Lankan female with a history of hypothyroidism presented with generalized body swelling and ascites, hypoalbuminemia, and no proteinuria, leading to a clinical suspicion of protein-losing enteropathy (PLE). Further investigation revealed significant alopecia, a high antinuclear antibody (ANA) titer of 1:1000, and hypocomplementemia, which, along with the absence of other causes for PLE, led to a diagnosis of systemic lupus erythematosus (SLE)-associated PLE. This diagnosis was made based on the European Alliance of Associations for Rheumatology (EULAR) criteria for SLE, despite the lack of specific confirmatory tests for PLE due to resource limitations. This case highlights the challenge of diagnosing PLE, a rare gastrointestinal manifestation of SLE, in settings with limited resources.
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