Bệnh mất protein qua ruột do Lupus ban đỏ hệ thống - Báo cáo ca bệnh hiếm

Abstract

Protein-losing enteropathy (PLE) is a rare but clinically significant complication of systemic lupus erythematosus (SLE), characterized by excessive loss of plasma proteins through the gastrointestinal tract, leading to persistent hypoalbuminemia, edema, and serous effusions. Due to its nonspecific clinical manifestations, overlapped with other causes of hypoalbuminemia, and limited availability of specialized diagnostic modalities, PLE is frequently underrecognized, particularly in patients with concomitant lupus nephritis, resulting in delayed or inappropriate management. We report a case of a 31-year-old woman with systemic lupus erythematosus and lupus nephritis admitted with a one-week history of persistent abdominal pain and nausea. Laboratory investigations revealed severe hypoalbuminemia disproportionate to the degree of proteinuria. Imaging studies demonstrated small bowel wall thickening and ascites. Technetium-99m–labeled human serum albumin scintigraphy identified focal protein leakage at the hepatic flexure of the colon, which was pivotal in confirming the diagnosis of protein-losing enteropathy. The patient responded favorably to high-dose corticosteroid therapy combined with mycophenolate mofetil, achieving complete clinical resolution and normalization of serum albumin levels after three months of follow-up.