Disclosing Hypoalbuminemia: A Lupus Protein-Losing Enteropathy (Lupple) Report

Abstract

Protein-losing enteropathy (PLE) is characterized by generalized oedema and severe hypoalbuminemia secondary to protein loss from the gastrointestinal tract. We report a case of Lupus protein-losing enteropathy (LUPPLE) as the presenting feature of systemic lupus erythematosus (SLE).

Our patient presented with 4 months of watery, non-bloody, diarrhoea (maximum of 10 stools per day) and significant weight loss. Later she developed severe peripheral oedema, malar and maculopapular erythematous rash in the thorax and limbs. Blood analysis showed anaemia, severe hypoalbuminemia, hypokalaemia, hypomagnesemia.

During the investigation proteinuria and other causes of hypoalbuminemia were excluded and a thorough differential diagnosis regarding the main causes of PLE was made. Positive Antinuclear and anti-ribonucleoprotein antibodies were found and LUPPLE was diagnosed. The patient was started on methylprednisolone pulses 1000 mg/day for 3 days, followed prednisolone 1 mg/kg/day, with great clinical response.

After 20 days, azathioprine was added as the tapering of corticosteroids ensued.

This clinical case portraits PLE as a rare form of presentation of SLE that, due to its uncommonness, can result in a missed diagnosis with consequent increase in morbidity and mortality.