Acute pancreatitis as first manifestation of systemic lupus erythematosus
Main Article Content
Keywords
Systemic Lupus Erythematosus, Pancreatitis, Autoimmune Diseases, Critical Illness
Abstract
Abstract
Background: Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with a broad clinical spectrum; gastrointestinal involvement can occur at any stage. SLE-associated pancreatitis is infrequent and exceptional as an initial manifestation, but it is associated with high morbidity and mortality. The objective was to describe a case of severe acute pancreatitis as the initial presentation of SLE and highlight its diagnostic and prognostic relevance.
Case report: A 22-year-old female with no significant medical history and a history of inflammatory arthralgia was admitted for intense abdominal pain and intractable vomiting. Acute pancreatitis was documented, progressing to severe necrotizing pancreatitis (Balthazar E), complicated by respiratory failure and admission to the intensive care unit. Given the absence of common risk factors and the presence of hemolytic anemia, a thorough immunological workup was performed, confirming autoimmunity with positive antinuclear and anti-dsDNA antibodies, diagnosing de novo SLE. Patient received high doses of corticosteroid treatment and immunosuppressive therapy, with a favorable clinical outcome.
Conclusions: Lupus pancreatitis is a marker of high systemic activity and severity, often underestimated by indices such as SLEDAI. Its timely recognition is fundamental to optimize the prognosis, requiring a multidisciplinary approach with early intensive support and immunosuppressive treatment.
References
1. Tani C, Elefante E, Arnaud L, et al. Rare clinical manifestations in systemic lupus erythematosus: a review on frequency and clinical presentation. Clin Exp Rheumatol. 2022;40 Suppl 134:93-102. doi: 10.55563/clinexprheumatol/jrz47c
2. Dima A, Balaban DV, Jurcut C, et al. Systemic lupus erythematosus-related acute pancreatitis. Lupus. 2021;30(1):5-14. doi: 10.1177/0961203320978515
3. Fanouriakis A, Kostopoulou M, Andersen J, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis. 2024;83(1):15-29. doi: 10.1136/ard-2023-224762
4. Frittoli RB, Vivaldo JF, Costallat LTL, et al. Gastrointestinal involvement in systemic lupus erythematosus: a systematic review. J Transl Autoimmun. 2021;4:100106. doi: 10.1016/j.jtauto.2021.100106
5. Alharbi S. Gastrointestinal manifestations in patients with systemic lupus erythematosus. Open Access Rheumatol Res Rev. 2022;14:243-53. doi: 10.2147/OARRR.S384256
6. Tenner S, Vege SS, Sheth SG, et al. American College of Gastroenterology Guidelines: Management of Acute Pancreatitis. Am J Gastroenterol. 2024;119(3):419-37. doi: 10.14309/ajg.0000000000002645
7. Brizi MG, Perillo F, Cannone F, et al. The role of imaging in acute pancreatitis. Radiol Med. 2021;126(8):1017-29. doi: 10.1007/s11547-021-01359-3
8. Zhang L, Qiao Z, Feng H, et al. The early predictive role of complement C3 and C4 in patients with acute pancreatitis. J Clin Lab Anal. 2020;34:e23205. doi: 10.1002/jcla.23205
9. Okazaki K, Kawa S, Kamisawa T, et al. Amendment of the Japanese consensus guidelines for autoimmune pancreatitis, 2020. J Gastroenterol. 2022;57(4):225-45. doi: 10.1007/s00535-022-01857-9
10. Williamson L, Hao Y, Basnayake C, et al. Systematic review of treatments for the gastrointestinal manifestations of systemic lupus erythematosus. Semin Arthritis Rheum. 2024;69:152567. doi: 10.1016/j.semarthrit.2024.152567
11. Duncan HV, Achara G. A rare initial manifestation of systemic lupus erythematosus—acute pancreatitis: case report and review of the literature. J Am Board Fam Pract. 2003;16(4):334-8. doi: 10.3122/jabfm.16.4.334
12. Parsan N, King D, Seeraj C, et al. A rare case of systemic lupus erythematosus-associated pancreatitis diagnosed in Trinidad and Tobago. Cureus. 2025;17(7):e87773. doi: 10.7759/cureus.87773
13. Muhammed H, Jain A, Irfan M, et al. Clinical features, severity and outcome of acute pancreatitis in systemic lupus erythematosus. Rheumatol Int. 2022;42(8):1363-71. doi: 10.1007/s00296-021-04834-2
14. Aouroud M, Machayi Fz, Aouroud H, et al. Acute pancreatitis as the initial manifestation of systemic lupus erythematosus: a case report. Scholars J Med Case Rep. 2025;13(5):971-3. doi: 10.36347/sjmcr.2025.v13i05.050
15. Abughazaleh S, Alsakarneh S, Hattar M, et al. Systemic lupus erythematosus in disguise: acute pancreatitis as initial presentation. J Investig Med High Impact Case Rep. 2023;11:23247096231185480. doi: 10.1177/23247096231185480
16. Khadka N, Kandel K, Mishra A, et al. Concurrent occurrence of acute pancreatitis and intracerebral hemorrhage as presenting manifestations in lupus: a case report. Ann Med Surg (Lond). 2023;85:4067-70. doi: 10.1097/MS9.0000000000001009
17. Alrashdi M, Alanazi MS, Almoaqly K, et al. Systemic lupus erythematosus with acute pancreatitis and vasculitic rash following COVID-19 vaccine: a case report and literature review. Clin Rheumatol. 2022;41(5):1577-82. doi: 10.1007/s10067-022-06097-z
18. Samanta J, Mitra S, Sen K, et al. Positive antinuclear antibody (ANA)-negative systemic lupus erythematosus presenting with acute pancreatitis. Cureus. 2022;14(3):e23031. doi: 10.7759/cureus.23031
19. Velasque Marques E, Cerqueira Batista Filho LA, Toledo Maciel A. Acute pancreatitis caused by systemic lupus erythematosus activity: a case report and literature review. Medwave. 2023;23(7):e2684. doi: 10.5867/medwave.2023.07.2684
20. Fasano S, Coscia MA, Valentini G. Subclinical pancreatitis as onset of systemic lupus erythematosus: case report and review of the literature. J Clin Rheumatol. 2021;27(8 Suppl):S520-4. doi: 10.1097/RHU.0000000000001133
Article Sidebar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.