Thrombosis secondary to protein-losing enteropathy (PLE): A case report and review

Abstract

Protein-losing enteropathy (PLE) is an uncommon diagnosis, caused by primary gastrointestinal disease, secondary to systemic disorders or an idiopathic condition. Little is known about its epidemiology, and it may be under-diagnosed, but case reports are increasing worldwide. The mechanism behind PLE is largely unknown, but involves excess protein loss through the gastrointestinal tract, in the absence of proteinuria, resulting in severe hypoalbuminemia. We report the case of a 35-year-old Asian-American female who presented with acute limb ischemia and was found to have recurrent thrombosis from PLE with underlying systemic lupus erythematous (SLE). A review of cases reporting thrombosis in PLE shows that venous events are twice as common as arterial. Peripheral vessels, cardiac, visceral and CNS vessels have all been reportedly affected. The ideal anticoagulation in PLE is not established and there are reports of heparin and warfarin resistance. Our case is the first to report use of dabigatran and aspirin in this setting Thrombosis in SLE should prompt consideration of not only antiphospholipid syndrome but also PLE. Larger studies defining PLE thrombotic risk and leading to evidence-based anticoagulation are urgently required.