We report the case of a young woman with systemic lupus erythematosus (SLE) complicated by protein-losing enteropathy, pure red cell aplasia (PRCA), transient anisocoria, laboratory evidence of autoimmune thyroiditis, and immune thrombocytopenia. Protein-losing enteropathy and PRCA are unusual manifestations of SLE (1,2) which, to our knowledge, have not been previously reported to occur in the same patient.Case report. This 22-year-old white woman presented at age 17 with extreme fatigue, palpitations, and pallor, 2 weeks after a mild febrile illness characterized by upper and lower respiratory tract symptoms. She had taken acetaminophen and propoxyphene hydrochloride for dysmenorrhea 3 weeks previously and pseudoephedrine hydrochloride and chlorpheniramine maleate during the antecedent respiratory illness.Laboratory studies revealed a hematocrit value of 14.6%, red blood cell count of 1.59 X 106/pl, hemoglobin of 4.7 gm/IOO ml, reticulocyte count of 0.3%, and haptoglobin level of 110 mg/dl. The direct The impression was that she had PRCA without thymoma. She received transfusions of packed red cells and was treated with prednisone, 80 mg/day, which was tapered over a 3-month period and then discontinued. Her hematocrit value returned to normal and has remained stable.Four years later, she presented to the University of Alabama at Birmingham Medical Center complaining of progressive fatigue, dizziness without syncope, periorbital edema with facial swelling, and intermittent pupillary asymmetry. She had also experienced skin photosensitivity manifested by the development of erythematous macules on the exposed skin after brief periods of sun exposure, associated with profound malaise, and in some instances, fever. The only remarkable finding on examination was generalized facial swelling. The laboratory evaluation was function. except there were persistently abnormal serology results, with ANA titers of 1 : 160 (homageneOuS pattern) and 1 : 640 (nucleolar pattern), anti-DNA of 19%, and a positive finding on direct Coombs'
