{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T08:08:47Z","timestamp":1789459727310,"version":"build-2803163510"},"reference-count":12,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T00:00:00Z","timestamp":1683676800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec><jats:title>Key Clinical Message<\/jats:title><jats:p>In low\u2010 and middle\u2010income countries, protein\u2010losing enteropathy is a diagnosis of exclusion. SLE should be on the list of differential diagnoses of protein\u2010losing enteropathy, especially if the patient had a long history of GI symptoms and ascites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>Protein\u2010losing enteropathy can rarely be the initial presentation of systemic lupus erythematosus (SLE). Protein\u2010losing enteropathy is a diagnosis of exclusion in low\u2010 and middle\u2010income countries. Protein\u2010losing enteropathy in SLE should be in the list of differential diagnosis of unexplained ascites, especially if patient had long history of gastrointestinal symptoms. We present a case of 33\u2009years old male with long standing gastrointestinal symptoms and diarrhea attributed previously to irritable bowel syndrome. Presented with progressive abdominal distension, and diagnosed with ascites. Workup for him showed leucopenia, thrombocytopenia, hypoalbumenemia, elevated inflammatory markers (ESR 30, CRP 6.6), high cholesterol level (306\u2009mg\/dL), normal renal profile and normal urine analysis. Ascitic tab pale yellow with SAAG 0.9 and positive for adenosine deaminase (66 u\/L) sugesstive for tuberculous peritonitis although quantitative PCR and geneXpert for MBT was negative. Antituberculous treatment was started and his condition deteriorated, immediately antituberculous was withdrawal. Further tests revealed positive serology for ANA (1:320 speckled pattern) with positive anti\u2010RNP\/Sm, positive anti\u2010Sm antibodies. Complements level were normal. He started immunosuppressive therapy (prednisolone 10\u2009mg\/day, hydroxychloroquine 400\u2009mg\/day, azathioprine 100\u2009mg\/day). In addition, his condition is improved Diagnosis was made as SLE with Protein\u2010losing enteropathy based on hypoalbumenemia (with exclusion of renal loss of protein), ascites, hypercholesrtolemia and exclusions of other mimics as explained later. As well as positive response to immunosuppressive medications. Our patient diagnosed clinically as SLE with protein\u2010losing enteropathy. Protein\u2010losing enteropathy in SLE is challenging in diagnosis because of its rarity as well as limitations in its diagnostic tests.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccr3.7314","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T05:59:36Z","timestamp":1683784776000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Protein\u2010losing enteropathy as the first presentation of systemic lupus erythematosus: A case report from Sudan"],"prefix":"10.1002","volume":"11","author":[{"given":"Elham","family":"Abdalla","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Bahri University  Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noon","family":"Mohymeed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Omdurman Islamic University  Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelsalam M. A.","family":"Nail","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Omdurman Islamic University  Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rayan Ali","family":"Tonga","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Sudan Medical Specialization Board  Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1786-7888","authenticated-orcid":false,"given":"Mohammed","family":"Alfatih","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Alzaiem Alazhari University  Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohannad","family":"Abdalfdeel\u00a0Almahie\u00a0Shaban","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Alzaiem Alazhari University  Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Eltoum","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Omdurman Islamic University  Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.4081\/cp.2011.e103"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203317707825"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0114684"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v16.i24.2971"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/09612033211049305"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/rheumato2040013"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.14309\/00000434-201510001-00954"},{"key":"e_1_2_10_9_1","article-title":"Ascites as the presenting sign of systemic lupus erythematosus","volume":"14","author":"Cook SG","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005176-200210000-00021"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-016-3630-0"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1620\/tjem.235.289"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1755-7682-5-1"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.7314","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T08:46:09Z","timestamp":1692434769000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.7314"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":12,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1002\/ccr3.7314"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.7314","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5]]},"assertion":[{"value":"2023-02-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e7314"}}