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Lupus-associated protein losing enteropathy (LUPLE) complicated by a hypercoagulable state and successfully treated with belimumab

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Abstract

Protein-losing enteropathy (PLE) is a condition characterized by gut mucosal injury that typically manifests with edema and hypoalbuminemia due to protein loss in the GI tract. We present a rare case of lupus-associated PLE (LUPLE) manifested by profound edema, diarrhea, and thrombotic complications. Through our case report, we discuss the typical clinical presentation, diagnostic studies available, and treatment options for these patients. Our patient’s clinical picture and laboratory markers improved with the initiation of corticosteroids and belimumab, which is a novel treatment regimen for LUPLE. Moreover, our patient was found to have a clinically significant hypercoagulable state that was ultimately attributed to PLE in the setting of systemic lupus erythematosus (SLE). We highlight the increased thrombotic risk in these patients and the subsequent management implications with regard to anticoagulation. Gastroenterologists are likely to be involved in the care of these patients, and may be the first to recognize the constellation of findings in PLE, leading to potentially very effective treatment.

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Funding

There are no relevant financial supports or conflicts to disclose.

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Authors and Affiliations

  1. Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code L461, Portland, OR, 97239, USA

    Justin S. Lewis

  2. Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR, USA

    Anil Sharma & Nir Modiano

  3. Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA

    Joel B. Horton & Atul Deodhar

Authors
  1. Justin S. Lewis
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  2. Anil Sharma
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  3. Joel B. Horton
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  4. Atul Deodhar
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  5. Nir Modiano
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Contributions

All authors provided substantial contributions to the conception and design of the work, assisted with drafting and revising the work, provided final approval of the version to be published, and are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. J.S. Lewis and A. Sharma wrote and edited the manuscript. J.B. Horton, A. Deodhar, and N. Modiano edited the manuscript. J.S. Lewis is the article guarantor.

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Correspondence to Justin S. Lewis.

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Conflict of interest

Justin S. Lewis, Anil Sharma, Joel B. Horton, Atul Deodhar, and Nir Modiano all declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained for the case report.

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This case report was previously presented at the Oregon Gut Club on September 21, 2019, in Stevenson, WA.

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Lewis, J.S., Sharma, A., Horton, J.B. et al. Lupus-associated protein losing enteropathy (LUPLE) complicated by a hypercoagulable state and successfully treated with belimumab. Clin J Gastroenterol 13, 771–774 (2020). https://doi.org/10.1007/s12328-020-01186-5

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  • DOI: https://doi.org/10.1007/s12328-020-01186-5

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