A 60-year-old man who had been diagnosed with protein-losing enteropathy (PLE) and vitiligo at age 51 years was admitted with dyspnea, hemoptysis, and lower-limb edema. On the basis of computed tomography findings, the cause of respiratory symptoms was thought to be diffuse alveolar hemorrhage (DAH). The final diagnosis of late-onset systemic lupus erythematosus (SLE) was established on the basis of renal biopsy examinations that revealed evidence of active SLE with lupus nephritis (World Health Organization, class V) and positive results for antinuclear antibody. DAH, as well as PLE and vitiligo were attributed to SLE. The patient was successfully treated with methylprednisolone and then prednisolone in combination with cyclosporin A. Because late-onset SLE is rare and patients tend to show atypical symptoms, close attention should be paid to the preceding symptoms.
Antibodies, Antinuclear ; Biopsy ; Cyclosporine ; Diagnosis ; Dyspnea ; Edema ; Hemoptysis ; Hemorrhage* ; Humans ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Methylprednisolone ; Middle Aged ; Prednisolone ; Protein-Losing Enteropathies* ; Vitiligo*

The activities for protecting health of inhabitants in the southern part of Ehime Prefecture (people call this part of the prefecture “Nan'yo”) has been developed by the Center of Rural Medicine, since it was established in November, 1965 as an auxiliary organization of the Ehime Prefectural Kitauwa Hospital.
Nan'yo covers an area of 1, 790.3 km² and has 348, 065 population (1970).It consists of two cities, nineteen towns and two villages, and has five Health Centers.
The phenomenon called “over-sparseness of population”, which is one of the manifestations of the contradiction inevitable to the capitalism in Japan is also observed more and more conspicuously in Nan'yo.
In this situation the Center of Rural Medicine pursues the activities of health protection based on the need of inhabitants as a part of the communal program for establishing health protection system, which is pushed forward in cooperation with the Health Centers, the Medical Association of Ehime Prefecture, Tottori University and the agricultural cooperative association.
The main features of the activities for protecting health of inhabitants are as follows.
1) To gain a closer cooperation of the administration of the prefecture
2) To establish a communal system of health protection in cooperation with various medical organizations
3) To establish hospitals based on the need of inhabitants
4) To urge the more substantial medical policy of the communities
5) To contribute to the deepening of understanding in social medicine of medical and paramedical students