Nephrotic Syndrome and Protein-Losing Enteropathy in a Patient with Suspected Systemic Lupus Erythematosus-A Case Report

疑似全身性紅斑性狼瘡合併腎病症候群及蛋白質流失性腸病變－一病例報告

張宗興(Chung-Hsin Chang) ； 呂理哲(Li-Che Lu) ； 江守山(Shou-Shan Chiang) ； 楊安航(An-Hang Yang)

《內科學誌》 16卷3期 (2005/06) Pp. 139-145

https://doi.org/10.6314/JIMT.2005.16(3).06

摘要

我們報告一位五十七歲之女性疑似全身性紅斑性狼瘡患者，其表徵爲全身水腫，肋膜積水，高膽固醇血症和嚴重的低白蛋白血症。首先，病人被發現有大量蛋白尿，腎臟生檢診斷爲膜性腎絲球炎並接受成功的治療。但兩年後病人又出現相同的臨床表徵並伴有腹瀉現象，然而此次未發現蛋白尿。在排除其他腸胃道蛋白質流失的原因後，我們診斷她爲全身性紅斑性狼瘡合併罕見的原發性蛋白質流失性腸病變，並在類固醇治療後達到完全緩解。本病例的特殊處在於不同之病灶表現出幾乎完全相同的臨床症狀。嚴重的低白蛋白血症和全身水腫卻未合併有重度蛋白尿之患者，需要我們做進一步之鑑別診斷和探討。

並列摘要

We report a 57-year-old female patient with suspected systemic lupus erythematosus presented with general anasarca, pleural effusions, hypercholesterolemia and severe hypoalbuminemia. First, nephrotic-range proteinuria was revealed and membranous glomerulonephritis was diagnosed and successfully treated. She developed diarrhea 2 years later with similar clinical presentations but this time no proteinuria was found. Primary protein-losing enteropthy, a rare complication of systemic lupus erythematosus, was diagnosed after other causes of gastrointestinal protein loss were excluded. Complete remission was achieved with steroid therapy. This case is unusual by the presentation of the same clinical pictures with different etiologies. Hypoalbuminemia and general anasarca need further investigation if renal protein loss was not found.

並列關鍵字

Systemic lupus erythematosus ； Hypoalbuminemia ； Hypercholesterolemia ； Nephrotic syndrome ； Protein-losing enteropthy