Debilitating chronic diarrhoea with resistant ascites: a case of lupus protein-losing enteropathy

Gastrointestinal manifestations occur in approximately 25 to 40 percent of patients with systemic lupus erythematosus (SLE)¹. Protein-losing enteropathy (PLE) in SLE, termed lupus protein-losing enteropathy (LUPLE),is a well-recognized clinical entity which is increasingly being noted in a number of case reports both locally and internationally^2,3. PLE is characterized by excessive loss of serum proteins from the gastrointestinal mucosa which subsequently leads to significant hypoalbuminaemia¹. Recently it is being frequently identified as the presenting feature of SLE^2,3. Ascites in SLE commonly occurs as a consequence of its complications such as PLE, nephrotic syndrome, constrictive pericarditis and Budd–Chiari syndrome as well as a part of the disease itself in the forms of acute and chronic lupus peritonitis⁶. We report a rare case of a Sri Lankan female extensively investigated for long term recurrent diarrhoea, vomiting and gradual onset massive ascites who was ultimately diagnosed to have SLE associated PLE and lupus enteritis.