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Nuwan Ranawaka, Inoshi Atukorala, Nilesh Fernandopulle, Meththananda Nawarathna, An unusual cause of generalized oedema in systemic lupus erythematosus, Rheumatology, Volume 51, Issue 12, December 2012, Pages 2298–2300, https://doi.org/10.1093/rheumatology/kes157
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Sir, It is unusual for protein-losing enteropathy (PLE) to be the initial presentation of SLE [1, 2]. Additionally, PLE followed by CNS vasculitis in SLE has been reported only once previously [2]. We report a case of a 13-year-old South Asian woman from Sri Lanka who presented with 3 years of generalized oedema due to PLE and then developed typical features of SLE complicated with neuropsychiatric lupus (NPSLE). There was dramatic improvement with immunosuppression.
This patient’s illness began in 2008 with periorbital oedema, which progressed within months to generalized oedema and ascites. She complained of infrequent episodes of watery diarrhoea and four motions per day on 3–4 days of the month. There was no passage of blood or mucus in stool or steatorrhoea or abdominal pain. She had no frothuria, haematuria, oliguria or features of renal impairment. There were no features to suggest chronic liver cell disease or cardiac failure. Her diet was adequate in protein. There was no previous history suggestive of SLE or SS. On admission to our unit, the patient’s BMI was 16 kg/m2 (weight 27 kg, height 130 cm). Except for generalized oedema, her examination was unremarkable.
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