20 May 2026
: Case report 
Lupus Enteritis With Concomitant Genitourinary Involvement as the Initial Presentation of Juvenile-Onset Systemic Lupus Erythematosus
Unusual clinical course, Challenging differential diagnosis, Unusual setting of medical care
Hanan Hassan AlMalki
ACDEF 1,2*, Muhammed Alhussain Alkhairi BEF 1, Fahad Saeed Alahmari BCE 1, Lujiun Abdalmoneim Almahboub AF 1
DOI: 10.12659/AJCR.952340
Am J Case Rep 2026; 27:e952340
Table 1 Investigation results of the patient at presentation and at last follow-up.
| Test (normal range) | At presentation | Last follow-up |
|---|---|---|
| Creatinine (0.6–1.1 mg/dL) | 0.73 | 0.69 |
| ALT (7–56 U/L) | 15 | 11 |
| AST (10–40 U/L) | 22 | 9 |
| Albumin (3.5–5.5 g/dL) | 2.6 | 4.1 |
| Total protein (6.0–8.3 g/dL) | 5.7 | 6.3 |
| Urine analysis | Protein: ++RBCs: 20–30/HPF | Protein: +RBCs: Nil |
| 24-hour urine protein (<0.5 g/day) | 2.674 | 0.7 |
| Hemoglobin (12–16 g/dL) | 8.9 | 15.8 |
| WBC count (4.0–11.0×10/μL) | 3.2 | 8.6 |
| Absolute neutrophil count (1.5–8.0×10/μL) | 2.04 | 6.54 |
| Absolute lymphocyte count (1.0–4.0×10/μL) | 0.68 | 1.61 |
| Platelets (150–450×10/μL) | 348 | 440 |
| Peripheral blood smear | Hypochromic microcytic anemia | – |
| Reticulocyte (0.5–2.5%) | 2.74 | – |
| ESR (0–20 mm/h) | 82 | 20 |
| CRP (<5 mg/L) | 18.50 | 3.2 |
| Ferritin (30–400 ng/mL) | 345 | |
| C3 (0.8–1.9 g/L) | 0.56 | 1.46 |
| C4 (0.15–0.4 g/L) | 0.10 | 0.39 |
| ANA (Normal <1: 80) | Titer 1: 640 (homogeneous) | – |
| Anti-dsDNA (Normal <4 IU/mL) | 300 | Negative |
| Anti-Smith (Normal <1 IU/mL) | 3.2 | – |
| Direct Coombs test | IgG: +2C3d: Negative | – |
| Ascitic fluid profile | 444/μL (70% lymphocytes) 1 g/dL 1.67 g/dL NegativeCytology: Reactive mesothelial cells | – |
| ALT – alanine aminotransferase; AST – aspartate aminotransferase; RBCs – red blood cells; WBC – white blood cell; ESR – erythrocyte sedimentation rate; CRP – C-reactive protein; ANA – antinuclear antibody; SAAG – serum; ascites albumin gradient; HPF – high-power field. | ||