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Lupus
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Systemic lupus erythematosus with concurrent protein-losing enteropathy and primary sclerosing cholangitis: a unique association

D CT Oh

Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore, daniel_oh{at}ttsh.com.sg

T M Ng

Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore

J Ho

Department of Pathology, Singapore General Hospital, Singapore

K P Leong

Department of Rheumatology and Immunology, Tan Tock Seng Hospital, Singapore

We describe a 24-year old male patient with systemic lupus erythematosus (SLE) with the gastrointestinal manifestations of protein-losing enteropathy (PLE) and primary sclerosing cholangitis (PSC). He presented with periorbital, scrotal and lower limb oedema. PLE was diagnosed because of hypoalbuminaemia together with an elevation of alpha-1-antitrypsin stool clearance and absence of proteinuria. PSC was diagnosed on the basis of an elevated serum alkaline phosphatase and lymphocytic and fibrous cholangitis. His disease was also complicated by neuropsychiatric lupus and hypogonadism. All the manifestations of SLE resolved with systemic corticosteroids and pulsed cyclophosphamide treatment. This case report documents the unusual association of SLE with PLE and PSC, and this relationship suggests that autoimmunity underlie the pathogenesis of these conditions.

Key Words: alpha-l antitrypsin • autoimmune • primary sclerosing cholangitis • protein-losing enteropathy • systemic lupus erythematosus

Lupus, Vol. 15, No. 2, 102-104 (2006)
DOI: 10.1191/0961203306lu2251cr
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