Acute pancreatitis and macrophage activation syndrome in pediatric systemic lupus erythematosus: case-based review

Abstract

Pancreatitis is uncommon in systemic lupus erythematosus (SLE) and is rarely reported in children, possibly being related to macrophage activation syndrome (MAS). The incidence of MAS in children with lupus pancreatitis is unknown, as is their prognosis. In this case-based review, we report a pediatric patient with SLE complicated with pancreatitis and MAS, and performed a literature review. We report an 11-year-old girl with SLE and MAS who developed pancreatitis on the second day of methylprednisolone pulse therapy (500 mg/day). We continued methylprednisolone pulse therapy, and performed three rounds of DNA-immunoadsorption and three rounds of hemoperfusion. A second course of methylprednisolone pulse therapy was initiated 9 days later. The patient received a monthly cyclophosphamide pulse therapy (10 mg/kg/day, 2 consecutive days every month) for 6 months, after which she was treated with mycophenolate mofetil 20 mg/kg/day. The condition of the patient gradually improved, her blood amylase and lipase decreased. She was in a stable condition during 13-month follow-up period. Review of the literature of pediatric patients with SLE and pancreatitis showed that there are 127 cases that have been reported in the past 30 years, 40 cases were excluded in our study because of inadequate information. Of the 87 patients included in our literature review, the mortality rate was 33.33%, and 52.86% of the patients with pancreatitis had MAS at the same time. Pancreatitis is uncommon in SLE, but must be suspected if a patient with SLE develops digestive symptoms. Patients with SLE with pancreatitis have a high incidence of MAS and high mortality rate; however, early recognition and effective treatment can relieve the disease symptoms.

Clinical Efficacy of Gandakang Tablets plus Methylprednisolone in Patients with Systemic Lupus Erythematosus

“…It has been noted that cumulative organ damage caused by the disease will seriously compromise the prognosis [ 4 ]. Therefore, the mitigation of the toxic side effects of low-dose drugs while ensuring the therapeutic benefits is the current priority of clinical research [ 5 ]. Methylprednisolone tablets are commonly used for SLE to hinder the growth of connective tissue and alleviate the inflammatory response.…”

Systemic lupus erythematosus‐related acute pancreatitis: An exceptional form with severe exocrine and endocrine pancreatitic failure in a Tunisian child

“…It is indicated especially with vasculitis and to improve the clinical and biological abnormalities 3 . Other studies combined immunosuppressive drugs like cyclophosphamide or azathioprine, plasmapheresis sessions, and intravenous immunoglobulin pulses with favorable outcome 15 . Although our patient received human immunoglobulin at 2 g/kg in addition to corticosteroid therapy, we noticed a worsening of the exocrine (from stage A to B of Balthazar classification) and endocrine pancreatitis revealed by diabetic ketoacidosis.…”

Macrophage Activation Syndrome in Pediatric Systemic Lupus Erythematosus: A Systematic Review of the Diagnostic Aspects

“…In addition to case reports and series, we also analyzed the four [actually five, including the paper by Sato et al (34)] clinical studies providing aggregated data on clinical and laboratory characteristics of MAS occurring in pSLE patients (11,33,(37)(38)(39). Those articles providing aggregated data for both adult and pediatric patients (without any chance to assess them separately) were excluded.…”