Systemic lupus erythematosus-related acute pancreatitis

Abstract

Introduction Systemic lupus erythematosus (SLE) is a complex autoimmune pathology that can involve any organ. Lupus-related acute pancreatitis (AP) is, together with lupus mesenteric vasculitis, an important cause of SLE-induced acute abdominal pain. Methods A literature search was conducted using the terms “Pancreatitis” and “Lupus Erythematosus, Systemic” on PubMed/Medline and Web of Science from January 2007 to January 2020. Clinical characteristics, diagnostic approach, and treatment principles in SLE-related AP are presented in this review. Results Mainly retrospective reports were identified. The reported incidence of SLE-associated AP ranges from 0.9 to more than 5% of patients. A total of 264 SLE patients were found in the selected research, with a net female predominance (sex ratio 9:1) and mean age of 31.4 years. Abdominal pain was virtually present in all cases. AP occurrence was more frequent in SLE patients with short disease duration, high activity scores, and multiorgan involvement. The AP definition was based on currently available guidelines and after exclusion of any other known causes (including iatrogenic, i.e. drugs), a diagnosis of “idiopathic” SLE-related AP might be sustained. Management is difficult, as there is no standardized therapeutic approach. Of note, glucocorticoid use remains still controversial as, especially for high doses, subsequent pancreatic injury may occur. Monitoring serum lipase levels after high dose steroids might be considered. One study reported beneficial prognostic effect of plasma exchange. Moreover, AP in SLE might raise awareness about macrophage activation syndrome association. Mortality up to one third of AP cases in SLE was reported. Conclusion The SLE-related AP is a rare, but severe, life-threatening complication. Corticosteroids must be used with caution. Plasma exchange could be considered in selected cases.

Agranulocytosis in systemic lupus erythematosus: A case report

“…Its prevalence varies between 0.5% and 17.5% in patients with SLE. 32 , 33 It carries a worse prognosis in SLE patients. So, prompt recognition and early treatment initiation are very important.…”

“…Testing for anti‐smooth muscle, anti‐liver‐kidney microsomal, or anti‐mitochondrial antibodies should be done. 32 , 33 , 34 , 35 …”

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

“… 1 While alcohol and gallstones represent the frequent etiologies, involvement of the pancreas in systemic lupus erythematosus (SLE) is rare. 2 Even in lupus, pancreatitis could result from different mechanisms including drug injuries or autoimmunity. 3 Although diagnosis seems to be easy based on abdominal pain and elevated serum pancreatic markers, its therapeutic management and prognosis are variable.…”

“…Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas presenting among the gastroenterological emergencies of the abdomen 1 . While alcohol and gallstones represent the frequent etiologies, involvement of the pancreas in systemic lupus erythematosus (SLE) is rare 2 . Even in lupus, pancreatitis could result from different mechanisms including drug injuries or autoimmunity 3 .…”

Systemic lupus erythematous presenting with hemorrhagic shock caused by gastric penetration of pancreatic pseudocyst: a case report

“…Fifty percent of SLE patients have digestive symptoms [ 2 ] and rarely develop pancreatitis. The incidence of SLE-associated pancreatitis ranges from 0.9% to more than 5% of patients [ 1 ]. The pathogenic mechanism underlying pancreatitis in SLE patients is unclear.…”