Acute Pancreatitis as Initial Presentation of Systemic Lupus Erythematosus –Review of 3 Cases
Systemic Lupus Erythematosus (SLE) is an autoimmune, chronic inflammatory disorder affecting mainly women. Gastrointestinal system is affected in about half of the SLE patients. SLE related gastrointestinal symptoms are clinically important as they can be life threatening if not treated immediately. Acute pancreatitis is considered as one of the rare complication of SLE and Lupus pancreatitis is more common in females and in the third decade of life with an incidence ranging from 0.7% to 4%. Here we report our experience on three cases of SLE who had acute pancreatitis as the primary presentation presented to Medicine department of Kasturba Hospital, Manipal.Three women in age group of 19 to 27 years presented with acute pancreatitis as an initial complaint and later on they were diagnosed as cases of Systemic Lupus Erythematosus associated pancreatitis. Clinical( fever,severe abdominal pain and vomiting) biochemical (elevated amylase and lipase) abdominal CT findings( thickened edematous bowel loop adjacent to pancreas with mild homogenous edema of pancreas) and immunological ( Positive Immunofluorescence ANA global and Positive ANA profile)confirmed the diagnosis.Treatment of SLE pancreatitis with steroids is controversial because of steroid induced toxic effects, however steroids can significantly improve prognosis in such patients because of their immunosuppressive effects and recent studies recommend the administration of steroids during the acute episode of SLE pancreatitis. As one case had sepsis, steroid could not be administered and the patient died. The second case was very sick during admission and died before receiving laboratory reports and diagnosis. The third case was treated with steroids and the patient improved.