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Lai JCT, Wu WKC, Chan WSA, Lau LHS, Leung HHW. Case 39-2023: A 43-Year-Old Woman with Chronic Diarrhea, Hair Loss, and Nail and Skin Changes. N Engl J Med 2023; 389:2377-2385. [PMID: 38118028 DOI: 10.1056/nejmcpc2301032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Affiliation(s)
- Jimmy C T Lai
- From the Department of Medicine and Therapeutics, Prince of Wales Hospital (J.C.T.L., W.K.C.W., W.S.A.C.), and the Departments of Medicine and Therapeutics (L.H.S.L.) and Anatomical and Cellular Pathology (H.H.W.L.), Chinese University of Hong Kong - both in Hong Kong
| | - W K Claudia Wu
- From the Department of Medicine and Therapeutics, Prince of Wales Hospital (J.C.T.L., W.K.C.W., W.S.A.C.), and the Departments of Medicine and Therapeutics (L.H.S.L.) and Anatomical and Cellular Pathology (H.H.W.L.), Chinese University of Hong Kong - both in Hong Kong
| | - W S Agnes Chan
- From the Department of Medicine and Therapeutics, Prince of Wales Hospital (J.C.T.L., W.K.C.W., W.S.A.C.), and the Departments of Medicine and Therapeutics (L.H.S.L.) and Anatomical and Cellular Pathology (H.H.W.L.), Chinese University of Hong Kong - both in Hong Kong
| | - Louis H S Lau
- From the Department of Medicine and Therapeutics, Prince of Wales Hospital (J.C.T.L., W.K.C.W., W.S.A.C.), and the Departments of Medicine and Therapeutics (L.H.S.L.) and Anatomical and Cellular Pathology (H.H.W.L.), Chinese University of Hong Kong - both in Hong Kong
| | - Howard H W Leung
- From the Department of Medicine and Therapeutics, Prince of Wales Hospital (J.C.T.L., W.K.C.W., W.S.A.C.), and the Departments of Medicine and Therapeutics (L.H.S.L.) and Anatomical and Cellular Pathology (H.H.W.L.), Chinese University of Hong Kong - both in Hong Kong
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Ng DM, Sek K, Nossent J. Protein-losing enteropathy as a rare manifestation of systemic lupus erythematosus. BMJ Case Rep 2023; 16:e256680. [PMID: 37640422 PMCID: PMC10462934 DOI: 10.1136/bcr-2023-256680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
- David Michael Ng
- Rheumatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Kenny Sek
- Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Johannes Nossent
- Rheumatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Rheumatology Unit, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder of unknown etiology. Women of childbearing age are affected approximately nine times more often than men. Its presentation and course are highly variable, ranging from mild to fulminant systemic disease. Any organ can be affected by SLE. Although less common than in other systems, such as the skin, joints, and kidneys, 40%–60% of SLE patients have gastrointestinal (GI) involvement. SLE can affect any part of the GI tract, from the mouth to the anus. GI manifestations can be caused by SLE, medication-related side effects, or non-SLE causes including infection. This article reviews the most common types of GI involvement associated with SLE.
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Affiliation(s)
- Samar Alharbi
- Department of Medicine, College of Medicine, Taibah University, Medina, Saudi Arabia,Correspondence: Samar Alharbi, Department of Medicine, College of Medicine, Taibah University, Medina, 42312-3779, Saudi Arabia, Tel +96 6553018777, Fax +96 648461172, Email
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Frittoli RB, Vivaldo JF, Costallat LTL, Appenzeller S. Gastrointestinal involvement in systemic lupus erythematosus: A systematic review. J Transl Autoimmun 2021; 4:100106. [PMID: 34179742 PMCID: PMC8214088 DOI: 10.1016/j.jtauto.2021.100106] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Gastrointestinal involvement is a common complain observed in 40–60% of systemic lupus erythematosus (SLE) patients. We performed a systematic review of clinically severe and potential life-threatening gastrointestinal manifestations and discuss clinical presentation, pathogenesis and treatment. Methods We performed a literature search in English literature using PubMed and Embase from 2000 to December 2020. The following MeSH terms: systemic lupus erythematosus, protein-losing enteropathy, ascites, pancreatitis, vasculitis, intestinal vasculitis, enteritis and diarrhea published in the English literature. Results We identified 141 studies (case reports, case series and cohort studies). The most frequent presenting symptoms are acute abdominal pain, nausea, and vomiting. Many of the manifestations were associated with disease activity. Histological features are rarely available, but both vasculitis and thrombosis have been described. There is no treatment guideline. The majority of patients were treated with corticosteroids and the most common immunososupressant were azathioprine, cyclophosphamide and mycophenolate. Conclusion Vasculitis and thrombosis may be responsible for severe life-threatening manifestations such as pancreatitis, protein loosing gastroenteritis, acalculous cholecistyitis and enteritis. Severe Gastrointestinal manifestations are rare, however potential life threatening. Vasculitis and thrombosis are the most frequent pathological mechanism described. Cohort studies with analysis of genetic risk factors and the role of autoantibodies could improve diagnosis and prognosis.
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Affiliation(s)
- Renan Bazuco Frittoli
- Post-Graduation in Medical Pathophysiology, School of Medical Science, University of Campinas, Brazil
| | - Jéssica Fernandes Vivaldo
- Graduate Program in Child and Adolescent Health, School of Medical Science, University of Campinas, Brazil
| | - Lilian Tereza Lavras Costallat
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas, São Paulo, 13083881, Brazil
| | - Simone Appenzeller
- Department of Medicine, School of Medical Science - State University of Campinas, Campinas, São Paulo, 13083881, Brazil.,Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas, São Paulo, 13083881, Brazil.,Post-Graduation in Medical Pathophysiology, School of Medical Science, University of Campinas, Brazil.,Graduate Program in Child and Adolescent Health, School of Medical Science, University of Campinas, Brazil
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Zhang J, Song H, Li D, Lv Y, Chen B, Zhou Y, Ding X, Chen C. Role of clinicopathological features for the early prediction of prognosis in lupus nephritis. Immunol Res 2021; 69:285-94. [PMID: 33954909 DOI: 10.1007/s12026-021-09201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
Ambiguities remain regarding the role of clinicopathological characteristics in the early prediction of the prognosis of lupus nephritis (LN). Systemic lupus erythematosus (SLE) patients who completed routine follow-up were identified and retrospectively reviewed for eligible cases. Poor prognosis was defined as all-cause mortality or a persistent decrease of eGFR greater than half the baseline level or progression to end-stage renal disease (ESRD). An optimal Cox regression model was constructed for the early prediction of a poor prognosis for LN. Among the 2163 SLE patients, 376 eligible LN cases were enrolled in the study, with a median follow-up time of 55 [27.0, 87.0] months. The male-to-female ratio was 1:7.2, and 37 patients (9.8%) progressed to the composite endpoint. The ISN/RPS class was significantly associated with proteinuria levels (P-value < 0.001), and class IV/IV + V patients, but not class V patients, had the most severe proteinuria. Our optimal multivariate Cox regression model indicated that sex, ISN/RPS class, tubular atrophy/interstitial fibrosis, serum albumin, tertiles of proteinuria, and their interaction were independently associated with a poor prognosis. ROC analysis and external validation demonstrated that our model was efficient and robust for distinguishing LN patients with a poor prognosis. Our study constructed a robust and early predictive model for convenience in clinical practice to identify poor prognosis in LN patients. We found a significant interaction effect between proteinuria and serum albumin for the prediction of poor prognosis. LN patients with low-level proteinuria and hypoalbuminemia exhibit an increased hazard of progression to poor outcomes.
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Peng L, Li Z, Xu D, Li M, Wang Y, Wang Q, Zhang S, Zhao J, Zeng X. Characteristics and Long-term Outcomes of Patients with Lupus-related Protein-losing Enteropathy: A Retrospective Study. Rheumatol Immunol Res 2020; 1:47-52. [PMID: 36465074 PMCID: PMC9524762 DOI: 10.2478/rir-2020-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/02/2020] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The long-term outcomes of patients with systemic lupus erythematosus (SLE)-related protein-losing enter-opathy (PLE) are unclear. This study was aimed to investigate the clinical characteristics and long-term outcomes of patients with SLE-related PLE. METHODS This retrospective cohort study enrolled 58 patients with SLE-related PLE who were admitted to our center from January 2000 to June 2016. The patients' baseline characteristics and follow-up data were analyzed, and the prognostic outcomes were survival and disease flares. The prognoses were analyzed using Kaplan-Meier curves, log-rank tests, and Cox regression models. Factors with values of P<0.05 were considered potential predictors. RESULTS Two-thirds of patients had intestinal symptoms, and 77.6% of patients had concomitant organ/system involvement, including serositis (77.6%), lupus nephritis (57.6%), neuropsychiatric lupus (10.3%), and hematological disorders (22.4%). Common abnormalities in the laboratory test results were hypocomplementemia (87.9%), anti-Sjögren syndrome antigen A antibodies (51.7%), and high total cholesterol levels (62.1%). Five flares were recorded in 47 patients. The 1-, 3-, and 5-year survival rates were 93.6%, 91.3%, and 88.4%, respectively. Infection was the cause of death in 60% of patients. High 24-hour urine protein level was an independent risk factor associated with death (P = 0.012). Severe hypoalbuminemia (<12 g/L) was a predictor of disease flares in SLE-related PLE (hazard ratio, 10.345; 95% confidence interval, 1.690-63.321). CONCLUSIONS Infection causes most of the deaths in patients with SLE-related PLE. High 24-hour urine protein level is an independent risk factor associated with death, and severe hypoalbuminemia is a predictor of disease flares.
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Affiliation(s)
- Liying Peng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Zhao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yanhong Wang
- Department of Epidemiology and Bio-statistics (YW), Institute of Basic Medical Science, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Shangzhu Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Ozen A. CHAPLE syndrome uncovers the primary role of complement in a familial form of Waldmann's disease. Immunol Rev 2019; 287:20-32. [PMID: 30565236 DOI: 10.1111/imr.12715] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/31/2018] [Indexed: 12/17/2022]
Abstract
Primary intestinal lymphangiectasia (PIL) or Waldmann's disease was described in 1961 as an important cause of protein-losing enteropathy (PLE). PIL can be the sole finding in rare individuals or occur as part of a multisystemic genetic syndrome. Although genetic etiologies of many lymphatic dysplasia syndromes associated with PIL have been identified, the pathogenesis of isolated PIL (with no associated syndromic features) remains unknown. Familial cases and occurrence at birth suggest genetic etiologies in certain cases. Recently, CD55 deficiency with hyperactivation of complement, angiopathic thrombosis, and PLE (the CHAPLE syndrome) has been identified as a monogenic form of PIL. Surprisingly, loss of CD55, a key regulator of complement system leads to a predominantly gut condition. Similarly to other complement disorders, namely paroxysmal nocturnal and hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS), CHAPLE disease involves pathogenic cross-activation of the coagulation system, predisposing individuals to severe thrombosis. The observation that complement system is overly active in CHAPLE disease introduced a novel concept into the management of PLE; anti-complement therapy. While CD55 deficiency constitutes a treatable subgroup in the larger pool of patients with isolated PIL, the etiology remains to be identified in the remaining patients with intact CD55.
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Affiliation(s)
- Ahmet Ozen
- Division of Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey.,The Istanbul Jeffrey Modell Diagnostic Center for Primary Immunodeficiency Diseases, Istanbul, Turkey
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8
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Abstract
Rheumatological diseases (RDs) represent a diverse group of diseases that are inherited or related to environmental factors. RDs frequently affect the gastrointestinal (GI) tract, and gastroenterologists are often asked to evaluate patients with symptoms thought to represent an underlying or coexisting RD. GI manifestations of RDs vary based on the organ involved as well as the extent and duration of involvement. Although most manifestations of RD are nonspecific and not life-threatening, the chronicity and severity of symptoms can be debilitating and may lead to serious injury. This narrative review discusses the most common RD encountered by gastroenterologists: systemic lupus erythematosus, systemic sclerosis (scleroderma), dermatomyositis/polymyositis, rheumatoid arthritis, Sjögren syndrome, overlap syndromes, mixed connective tissue disease, Ehlers-Danlos syndromes, and other vasculitides. Each section begins with a brief overview of the condition, followed by a discussion of the etiopathophysiology, physical examination findings, GI manifestations, diagnostic tools (i.e., serologic, imaging, endoscopic, and functional), and treatment options.
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Xibillé-friedmann D, Pérez-rodríguez M, Carrillo-vázquez S, Álvarez-hernández E, Aceves FJ, Ocampo-torres MC, García-garcía C, García-figueroa JL, Merayo-chalico J, Barrera-vargas A, Portela-hernández M, Sicsik S, Andrade-ortega L, Rosales-don Pablo VM, Martínez A, Prieto-seyffert P, Pérez-cristóbal M, Saavedra MÁ, Castro-colín Z, Ramos A, Huerta-sil G, Hernández-cabrera MF, Jara LJ, Limón-camacho L, Tinajero-nieto L, Barile-fabris LA. Guía de práctica clínica para el manejo del lupus eritematoso sistémico propuesta por el Colegio Mexicano de Reumatología. ACTA ACUST UNITED AC 2019; 15:3-20. [DOI: 10.1016/j.reuma.2018.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 12/31/2022]
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Jiajie Z, Shan L, Xiaolan S, Yu G, Yijie L, Jiande C, Qingguo W, Wei W. Protein losing enteropathy caused by eosinophilic gastroenteritis: A case report. J TRADIT CHIN MED 2018. [DOI: 10.1016/s0254-6272(18)30996-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nishino A, Hanaoka M, Katsumata Y, Kawaguchi Y, Yamanaka H. Technetium-99m Albumin Scintigraphy in Protein-Losing Gastroenteropathy With Systemic Lupus Erythematosus: Typical Diagnostic Pattern of Radiotracer Leakage and Chronological Improvement by Treatment. J Clin Rheumatol 2017; 23:41-2. [PMID: 28002156 DOI: 10.1097/RHU.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sansinanea P, Carrica SA, Marcos J, García MA. Enteropatía perdedora de proteínas asociada a lupus eritematoso sistémico refractaria con buena respuesta a rituximab. ACTA ACUST UNITED AC 2016; 12:47-9. [DOI: 10.1016/j.reuma.2015.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 01/20/2015] [Accepted: 01/23/2015] [Indexed: 11/21/2022]
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Lim DH, Kim YG, Bae SH, Ahn S, Hong S, Lee CK, Yoo B. Factors related to outcomes in lupus-related protein-losing enteropathy. Korean J Intern Med 2015; 30:906-12. [PMID: 26552467 PMCID: PMC4642021 DOI: 10.3904/kjim.2015.30.6.906] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 11/21/2014] [Accepted: 12/01/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Protein-losing enteropathy (PLE), characterized by severe hypoalbuminemia and peripheral edema, is a rare manifestation of systemic lupus erythematosus. This present study aimed to identify the distinctive features of lupus-related PLE and evaluate the factors related to the treatment response. METHODS From March 1998 to March 2014, the clinical data of 14 patients with lupus PLE and seven patients with idiopathic PLE from a tertiary center were reviewed. PLE was defined as a demonstration of protein leakage from the gastrointestinal tract by either technetium 99m-labelled human albumin scanning or fecal α1-antitrypsin clearance. A positive steroid response was defined as a return of serum albumin to ≥ 3.0 g/dL within 4 weeks after initial steroid monotherapy, and remission as maintenance of serum albumin ≥ 3.0 g/dL for at least 3 months. A high serum total cholesterol level was defined as a level of ≥ 240 mg/dL. RESULTS The mean age of the lupus-related PLE patients was 37.0 years, and the mean follow-up duration was 55.8 months. Significantly higher erythrocyte sedimentation rate and serum total cholesterol levels were found for lupus PLE than for idiopathic PLE. Among the 14 patients with lupus PLE, eight experienced a positive steroid response, and the serum total cholesterol level was significantly higher in the positive steroid response group. A positive steroid response was associated with an initial high serum total cholesterol level and achievement of remission within 6 months. CONCLUSIONS In lupus-related PLE, a high serum total cholesterol level could be a predictive factor for the initial steroid response, indicating a good response to steroid therapy alone.
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Affiliation(s)
| | - Yong-Gil Kim
- Correspondence to Yong-Gil Kim, M.D. Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3279 Fax: +82-2-3010-6969 E-mail:
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Liao CY, Chien ST, Wang CC, Chen IH, Chiu HW, Liu MY, Lin CH, Ben RJ, Tsai MK. Sjögren's syndrome associated with protein losing gastroenteropathy manifested by intestinal lymphangiectasia successfully treated with prednisolone and hydroxychloroquine. Lupus 2015; 24:1552-6. [PMID: 26169478 DOI: 10.1177/0961203315596078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/18/2015] [Indexed: 11/17/2022]
Abstract
Protein-losing gastroenteropathy (PLGE), a rare manifestation of primary Sjögren's syndrome (SS), is characterized by profound edema and severe hypoalbuminemia secondary to excessive serum protein loss from the gastrointestinal tract and is clinically indistinguishable from nephrotic syndrome. We report a case of a 30-year-old Taiwanese woman with PLGE-associated SS. In addition to a positive Schirmer's test, she had eye-dryness, thirst, and high levels of anti-SSA antibodies, fulfilling SS criteria. PLGE diagnosis was highly appropriate given the clinical profile of hypoalbuminemia, hypercholesterolemia, pleural effusion, and ascites, with absent cardiac, hepatic, or renal disease. We were unable to perform technetium-99 m-labeled human serum albumin scintigraphy ((99m)Tc-HAS). However, the patient's edema and albumin level improved dramatically in response to a 3-month regime of oral prednisolone followed by oral hydroxychloroquine.
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Affiliation(s)
- C-Y Liao
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - S-T Chien
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - C-C Wang
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - I-H Chen
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - H-W Chiu
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - M-Y Liu
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - C-H Lin
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - R-J Ben
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - M-K Tsai
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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Chen Z, Li MT, Xu D, Yang H, Li J, Zhao JL, Zhang HH, Han SM, Xu T, Zeng XF. Protein-losing enteropathy in systemic lupus erythematosus: 12 years experience from a Chinese academic center. PLoS One 2014; 9:e114684. [PMID: 25490025 PMCID: PMC4260872 DOI: 10.1371/journal.pone.0114684] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 11/12/2014] [Indexed: 01/08/2023] Open
Abstract
Objective Protein-losing enteropathy (PLE) is a complication in some systemic lupus erythematosus (SLE) patients that is often misdiagnosed. With this study, we provide insight into clinical characteristics, laboratory characteristics, diagnostic tests, risk factors, treatment, and prognosis of the disease. Methods A retrospective, case-control study was performed in 44 patients with SLE-related PLE (PLE group) and 88 patients with active SLE (control group) admitted to our care from January 2000−January 2012. Risk factors for SLE-related PLE were examined, and we analyzed the accuracy of single and combined laboratory characteristics in discriminating SLE-related PLE from active SLE. Serum albumin and C3 levels were measured as outcome during and after treatment with corticosteroids and immunosuppressive agents. Results The PLE group had lower mean serum albumin and 24-hour urine protein levels, higher mean total plasma cholesterol levels, and greater frequencies of anti-SSA and SSB seropositivity compared with the control group. Anti-SSA seropositivity, hypoalbuminemia, and hypercholesterolemia were independent risk factors for SLE-related PLE. The simultaneous presence of serum albumin (<22 g/l) and 24-hour urine protein (<0.8 g/24 h) had high specificity, positive predictive value, negative predictive value, and positive likelihood ratio, a low negative likelihood ratio and no significant reduction in sensitivity. High dosage of glucocorticosteroid combined with cyclophosphomide were mostly prescribed for SLE-related PLE. Conclusion SLE-related PLE should be considered when an SLE patient presents with generalized edema, anti-SSA antibody seropositivity, hypercholesterolemia, severe hypoalbuminemia, and low 24-hour urine protein levels. Aggressive treatment for lupus might improve prognosis.
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Affiliation(s)
- Zhen Chen
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China, and Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Meng-Tao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China, and Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China, and Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Hong Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jing Li
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China, and Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiu-Liang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China, and Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Heng-Hui Zhang
- Peking University People’s Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing, China
| | - Shao-Mei Han
- Department of Epidemiology and Statistics, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiao-Feng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China, and Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
- * E-mail:
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Abstract
There have been a number of major advances in the treatment of systemic lupus erythematosus and we are now in the era of biologic therapies for this multisystem autoimmune disorder. There has been a greater awareness of the toxicities of the traditional therapies including the recognition that the doses of corticosteroids used in the past have been excessive, resulting in unacceptable toxicities. Other advances have included the development of lower cumulative doses of cyclophosphamide and the widespread acceptance of mycophenolate mofetil for the treatment of lupus nephritis. This review addresses the current management of severe lupus with corticosteroids and cytotoxic agents.
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Affiliation(s)
- Pamela M K Lutalo
- Louise Coote Lupus Unit, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom; King's College School of Medicine, Peter Gorer Department of Immunobiology, 2nd Floor, Borough Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Natasha Jordan
- Louise Coote Lupus Unit, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom; Centre for Molecular and Cellular Biology of Inflammation King's College London - Guy's Campus New Hunt's House, 1st Floor, London SE1 1UL, United Kingdom
| | - David P D'Cruz
- Louise Coote Lupus Unit, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom. david.d'
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Abstract
Physicians in practice should be knowledgeable regarding several aspects of autoimmune disorders, especially systemic lupus erythematosus (SLE) and lupus nephritis. These disorders can present to the clinician's clinic and private office regardless of their specialty. This review will discuss various aspects of SLE, its mechanisms of disease, role of accelerated atherosclerosis, proinflammatory cytokines, and therapeutic approaches. The role of vascular endothelial growth factor in which and plasma levels have been associated with disease activity, classification of severity, and diagnosis of lupus nephritis is addressed. Current treatment options, prognosis, and future therapeutic approaches and common side effects are also discussed.
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