{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:40:05Z","timestamp":1756320005053,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,5,20]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:p>A previously well 37-year-old woman attended the emergency assessment unit with symptoms of lethargy, breathlessness and peripheral oedema, whereby initial basic investigations revealed an iron deficiency anaemia and serum hypoalbuminaemia. The patient subsequently had multiple admissions to secondary care over a 2-year period due to worsening peripheral and central oedema. Investigations ruled out non-gastrointestinal causes of serum hypoalbuminaemia, such as renal, cardiac and hepatic failures. Gastrointestinal investigations later revealed raised faecal alpha-1 antitrypsin and small bowel ulceration on capsule endoscopy, with a histological diagnosis of Crohn\u2019s disease made after a small bowel wedge resection. This case describes the unusual presentation of Crohn\u2019s disease displaying symptoms primarily of protein-losing enteropathy, an uncommon and under-recognised consequence of inflammatory bowel disease. A review of current literature and the underlying pathophysiology for this rare condition are discussed, particularly in relation to Crohn\u2019s disease.<\/jats:p>","DOI":"10.1136\/bcr-2021-242703","type":"journal-article","created":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T11:48:45Z","timestamp":1623239325000},"page":"e242703","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Unusual presentation of Crohn\u2019s disease"],"prefix":"10.1136","volume":"14","author":[{"given":"Kate","family":"Edwards","sequence":"first","affiliation":[{"name":"Gastroenterology, Nevill Hall Hospital, Abergavenny, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Yearsley","sequence":"additional","affiliation":[{"name":"Gastroenterology, Nevill Hall Hospital, Abergavenny, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,6,9]]},"reference":[{"key":"2025082711154170000_14.6.e242703.1","doi-asserted-by":"crossref","first-page":"147","DOI":"10.2147\/CEG.S136803","article-title":"Protein losing enteropathy: comprehensive review of the mechanistic association with clinical and subclinical disease states","volume":"10","author":"Levitt","year":"2017","journal-title":"Clin Exp Gastroenterol"},{"key":"2025082711154170000_14.6.e242703.2","first-page":"464","volume-title":"Sleisenger and Fordtran\u2019s Gastrointestinal and Liver Disease","volume":"Vol 1","author":"Greenwald","year":"2016"},{"key":"2025082711154170000_14.6.e242703.3","first-page":"384","article-title":"Protein-losing enteropathy in Crohn's disease","volume":"69","author":"Ferrante","year":"2006","journal-title":"Acta Gastroenterol Belg"},{"key":"2025082711154170000_14.6.e242703.4","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/MOG.0000000000000629","article-title":"Protein-losing enteropathy","volume":"36","author":"Elli","year":"2020","journal-title":"Curr Opin Gastroenterol"},{"key":"2025082711154170000_14.6.e242703.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(78)92650-8"},{"key":"2025082711154170000_14.6.e242703.6","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2019-318484"},{"key":"2025082711154170000_14.6.e242703.7","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S102819"},{"key":"2025082711154170000_14.6.e242703.8","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.561"},{"key":"2025082711154170000_14.6.e242703.9","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2013-201885"},{"key":"2025082711154170000_14.6.e242703.10","first-page":"1990","volume-title":"Sleisenger and Fordtran\u2019s gastrointestinal and liver disease","volume":"Vol 2","author":"Sands","year":"2016"},{"key":"2025082711154170000_14.6.e242703.11","doi-asserted-by":"publisher","DOI":"10.1023\/B:JOCI.0000019784.20191.7f"},{"key":"2025082711154170000_14.6.e242703.12","doi-asserted-by":"publisher","DOI":"10.1136\/gut.24.8.718"},{"key":"2025082711154170000_14.6.e242703.13","doi-asserted-by":"publisher","DOI":"10.1136\/gut.28.4.386"},{"key":"2025082711154170000_14.6.e242703.14","doi-asserted-by":"publisher","DOI":"10.1097\/00042737-200303000-00009"},{"key":"2025082711154170000_14.6.e242703.15","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.122.7.1067"},{"key":"2025082711154170000_14.6.e242703.16","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200746080-00002"},{"key":"2025082711154170000_14.6.e242703.17","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.revmed.2014.12.001","article-title":"Gastro-ent\u00e9ropathies exsudatives [Protein-losing enteropathy]","volume":"36","author":"Amiot","year":"2015","journal-title":"Rev Med Interne"},{"key":"2025082711154170000_14.6.e242703.18","first-page":"261","article-title":"Protein-losing enteropathy in inflammatory bowel diseases","volume":"61","author":"Furfaro","year":"2015","journal-title":"Minerva Gastroenterol Dietol"},{"key":"2025082711154170000_14.6.e242703.19","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s11739-012-0802-0","article-title":"Hypoalbuminemia","volume":"7","author":"Gatta","year":"2012","journal-title":"Intern Emerg Med"},{"key":"2025082711154170000_14.6.e242703.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2013.05.015"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-242703","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:15:49Z","timestamp":1756318549000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-242703"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,9]]},"published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1136\/bcr-2021-242703"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-242703","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,6]]}}}