Bilateral Serous Macular Elevation Associated with Lupus Protein-losing Enteropathy

245 Dear Editor, We describe two clinical cases of patients who first presented to ophthalmologists with bilateral serous macular elevation and generalized edema. They were later diagnosed with lupus protein‐losing enteropathy complicated with life‐threatening conditions and were treated with immunosuppressants. As ophthalmic symptoms could be the initial presentation of this disease, our report highlights the importance of careful systemic review and early referral to reduce the morbidity and mortality. Two middle‐aged Chinese men presented with subacute blurred vision, periorbital swelling, chemosis, and bilateral ankle edema for one week. Their best corrected visual acuity ranged from 0.3 to 0.5 LogMAR. Examination revealed bilateral serous macular elevation. Optical coherent tomography showed macular elevation ranged from 726 to 800 μm with significant subretinal fluid accumulation. Fluorescein angiography revealed multiple leakage points at the level of the retinal pigment epithelium, without any vascular leakage. Both patients had severe hypoalbuminemia with albumin levels of 13 g/L and 29 g/L, respectively (normal value, 35–50 g/L). Liver and renal function tests were normal. Autoimmune markers including anti‐nuclear antibody, rheumatoid factor, erythrocyte sedimentation rate, and C‐reactive protein levels were all markedly elevated. Albumin scan using Tc‐99m human serum albumin revealed increased tracer activity in the proximal small bowel. Both patients were diagnosed with lupus protein‐losing enteropathy. Clinical investigations showed that both patients had ascites and pleural effusion. The condition of the first patient was further complicated with deep venous Bilateral Serous Macular Elevation Associated with Lupus Protein‐losing Enteropathy