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Watanabe N, Kaneko R, Kishi M, Yanai R, Ikehara T, Nagai H, Matsuda T. A case of protein-losing gastroenteropathy due to Sjögren's syndrome detected by foggy vision with refractive error of the intraocular lens. Clin J Gastroenterol 2024:10.1007/s12328-024-02038-2. [PMID: 39297920 DOI: 10.1007/s12328-024-02038-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 09/10/2024] [Indexed: 09/21/2024]
Abstract
A woman in her forties visited an ophthalmologist for rapidly progressive foggy vision. Naked visual acuity had decreased to 0.15, and although her eyes showed no abnormalities, internal disease was suspected and albumin 2.6 g/dL was found. Protein leakage from the intestinal tract was suspected since there was no urinary protein excretion. 99mTechnetium-labeled albumin D scintigraphy showed protein leakage from the intestinal tract. A stool α1-antitrypsin clearance test showed an increase to 56.3 mL/day, leading to a diagnosis of protein-losing gastroenteropathy. Blood biochemistry revealed abnormally high levels of anti-SS-A and anti-SS-B antibodies (≥ 1200 U/mL and ≥ 1000 U/mL, respectively). A lip salivary gland biopsy revealed lymphocytic infiltrate at least 1 focus per 2 mm × 2 mm > 50 lymphocytes per conduit). The Schirmer test result was 5 mm/5 min or less, which led to the diagnosis of Sjögren's syndrome. The serum albumin level increased with intravenous administration of methylprednisolone 50 mg (1 mg/kg), and the patient is currently on oral prednisolone at a gradually decreasing dose. After administration of prednisolone, visual acuity recovered to 1.2 with recovery of albumin.
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Affiliation(s)
- Naho Watanabe
- Department of Gastroenterology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Rena Kaneko
- Department of Gastroenterology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.
| | - Monami Kishi
- Department of Pathology and Diagnostics, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Japan
| | - Ryo Yanai
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Takashi Ikehara
- Department of Gastroenterology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hidenari Nagai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
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2
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de Carvalho JF, Lerner A, Gonçalves CM, Shoenfeld Y. Sjögren syndrome associated with protein-losing enteropathy: case-based review. Clin Rheumatol 2020; 40:2491-2497. [PMID: 33145631 DOI: 10.1007/s10067-020-05487-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
The association between Sjögren's syndrome (SS) and protein-losing enteropathy (PLE) was scarcly reported. To analyze the clinical, therapeutic, and outcome characteristics of patients with SS and PLE and also to delineate the potential mechanisms and pathways connecting the gut to SS targeted organ's pathology. Systematic screening was conducted using PubMed/MEDLINE, LILACS, SciELO, Web of Science, and Cochrane, dating 1980 to 2020. SS and PLE were the key words. Eighteen patients with SS and PLE were summarized. The patient's ages ranged between 20 and 88 years, and only 4 were males. Primary SS was observed in most cases. Anti-Ro was detected in 100% of the cases while anti-La was reported in 64% of them. The clinical manifestations were protein loss, edema of the lower limbs, pleural effusion, ascites, facial edema, anasarca, diarrhea, and weight loss. Among these clinical manifestations, edema of the lower limbs was the most severe. Albumin concentration was 0.9-3.4 g/dL which increased to 2.8-4.3 g/dL after treatment. Small bowel biopsy was performed in all of the cases. Concerning the therapy, all the patients received systemic glucocorticoids. All of them improved. The period of onset of improvement ranged from 3 weeks to 36 months (an average of 3 months). The early diagnosis and appropriate therapy of PLE in patients with anti-Ro positive SS and who present edema, anasarca, or hypoalbuminemia is vital for a beneficial outcome. An excellent clinical improvement in all the cases was observed when treated early enough by cortico-therapy, thus preventing patient's deterioration, complications, and reducing morbidity and potential mortality.
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Affiliation(s)
- Jozélio Freire de Carvalho
- Institute for Health Sciences from Federal University of Bahia, Rua das Violetas, 42, ap. 502, Pituba, Salvador, Bahia, Brazil.
| | - Aaron Lerner
- Chaim Sheba Medical Center, The Zabludowicz Research Center for Autoimmune Diseases, Tel Hashomer, Israel
| | | | - Yehuda Shoenfeld
- Chaim Sheba Medical Center, The Zabludowicz Research Center for Autoimmune Diseases, Tel Hashomer, Israel.,Saint Petersburg State University, St. Petersburg, Russia
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Li X, Lin F, Wu Z, Chen Y, Zhu P. A case report of Sjögren's syndrome associated with protein-losing gastroenteropathy successfully treated with methylprednisolone. J Int Med Res 2020; 48:300060519874543. [PMID: 31594442 PMCID: PMC7783283 DOI: 10.1177/0300060519874543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Protein-losing gastroenteropathy (PLGE) is a rare manifestation of primary
Sjögren’s syndrome that is most commonly reported in Japan. Herein, the case of
a 71-year-old Chinese male patient, diagnosed with PLGE and Sjögren’s syndrome,
is reported. The patient presented with peripheral oedema, and PLGE was
diagnosed based on the result of technetium-99m (99mTc)-labelled
albumin scintigraphy. In addition to a positive Schirmer’s test, the patient had
atrophy of the salivary gland with lymphocyte infiltration, impaired
parotid-gland secretory and excretory function, and an increased level of
anti-SSA antibodies, fulfilling the criteria for Sjögren’s syndrome. He was
successfully treated with methylprednisolone. Follow-up
99mTc-labelled albumin scintigraphy results correlated well with
clinical improvement and increased serum albumin levels. The present case study
highlights the necessity of considering a diagnosis of protein loss enteropathy
associated with primary Sjögren’s syndrome when patients have unexplained
hypoproteinaemia.
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Affiliation(s)
- Xiaoming Li
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Provincial Key Laboratory of Geriatric Diseases, Fujian Medical University, Fuzhou, China
| | - Fan Lin
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Provincial Key Laboratory of Geriatric Diseases, Fujian Medical University, Fuzhou, China
| | - Ziyu Wu
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Provincial Key Laboratory of Geriatric Diseases, Fujian Medical University, Fuzhou, China
| | - Yan Chen
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Provincial Key Laboratory of Geriatric Diseases, Fujian Medical University, Fuzhou, China
| | - Pengli Zhu
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Provincial Key Laboratory of Geriatric Diseases, Fujian Medical University, Fuzhou, China
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Akaishi T, Yasaka K, Abe M, Fujii H, Watanabe M, Shirai T, Ishizawa K, Takayama S, Kagaya Y, Harigae H, Ishii T. Protein-losing gastroenteropathy with severe hypoalbuminemia associated with Sjögren's syndrome: A case report and review of the literature. J Gen Fam Med 2020; 21:24-28. [PMID: 31911886 PMCID: PMC6942935 DOI: 10.1002/jgf2.281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 12/16/2022] Open
Abstract
A 30-year-old man with severe hypoalbuminemia (serum albumin: 0.9 g/dL) was admitted with severe bilateral leg edema and unilateral pleural effusion. Serum anti-SS-A and SS-B antibody levels were abnormally elevated, and his symptoms fulfilled the diagnostic criteria for Sjögren's syndrome. Technetium-99m albumin scintigraphy revealed protein leakage from a large area of the small intestine. Immunohistochemistry revealed perivascular deposition of C1q, C3d, and immunoglobulin G in the duodenal mucosa. The patient was diagnosed with protein-losing gastroenteropathy associated with Sjögren's syndrome. Within 2 months of treatment with oral prednisolone and mycophenolate mofetil, the clinical symptoms of hypoalbuminemia and Sjögren's syndrome disappeared completely.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Education and Support for Regional MedicineTohoku University HospitalSendaiJapan
| | - Ken Yasaka
- Department of Hematology and RheumatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Michiaki Abe
- Department of Education and Support for Regional MedicineTohoku University HospitalSendaiJapan
| | - Hiroshi Fujii
- Department of Hematology and RheumatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Mika Watanabe
- Department of PathologyTohoku University HospitalSendaiJapan
| | - Tsuyoshi Shirai
- Department of Hematology and RheumatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Kota Ishizawa
- Department of Education and Support for Regional MedicineTohoku University HospitalSendaiJapan
| | - Shin Takayama
- Department of Education and Support for Regional MedicineTohoku University HospitalSendaiJapan
| | - Yutaka Kagaya
- Office of Medical EducationTohoku University Graduate School of MedicineSendaiJapan
| | - Hideo Harigae
- Department of Hematology and RheumatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Tadashi Ishii
- Department of Education and Support for Regional MedicineTohoku University HospitalSendaiJapan
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Watanabe K, Murakami S, Misago M, Yoshikawa M, Tamai D, Nakao S, Ueoka T, Ito M, Shinomura Y, Kajiwara N. Sjögren's syndrome concurrent with protein-losing gastroenteropathy with secondary systemic capillary leak syndrome : A case report. Clin Case Rep 2018; 6:1829-1833. [PMID: 30214773 PMCID: PMC6132162 DOI: 10.1002/ccr3.1675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/04/2018] [Accepted: 06/12/2018] [Indexed: 02/06/2023] Open
Abstract
Sjögren's syndrome concurrent with protein-losing gastroenteropathy can develop into secondary systemic capillary leak syndrome. Thus, it is important to diagnose the condition as soon as possible and simultaneously administer treatment for Sjögren's syndrome, protein-losing gastroenteropathy, and systemic capillary leak syndrome.
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Affiliation(s)
- Kei Watanabe
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Shinichiro Murakami
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Masahiro Misago
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Mai Yoshikawa
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Daisuke Tamai
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Shinichiro Nakao
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Takato Ueoka
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
| | - Mototoshi Ito
- Department of Emergency and General MedicineIkeda City HospitalIkedaOsakaJapan
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Nakamura T, Shiraishi N, Morikami Y, Fujii H, Itoshima H, Kamio T. Protein-losing enteropathy may be an important characteristic manifestation in Sjögren's syndrome. Mod Rheumatol 2018. [PMID: 29532703 DOI: 10.1080/14397595.2018.1452335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Tadashi Nakamura
- a Section of Clinical Rheumatology , Sakurajyuji Hospital , Kumamoto , Japan
| | - Naoki Shiraishi
- b Section of Nephrology , Sakurajyuji Hospital , Kumamoto , Japan
| | | | - Hiromi Fujii
- c Section of Cardiology , Sakurajyuji Hospital , Kumamoto , Japan
| | - Hisashi Itoshima
- d Section of Gastroenterology , Saiseikai Kumamoto Hospital , Kumamoto , Japan
| | - Takihiro Kamio
- e Section of Clinical Pathology , Saiseikai Kumamoto Hospital , Kumamoto , Japan
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