Silence pancreatitis in systemic lupus erythematosus

Area of Science:

• Rheumatology
• Gastroenterology
• Radiology

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
• Pancreatitis is a known, though less common, complication of SLE and its treatments.

Observation:

• A 35-year-old female SLE patient with high disease activity (SLE Disease Activity Index > 15) presented with disease exacerbation.
• Computed tomography (CT) was used to assess pancreatitis in this patient.
• The pancreatitis was subclinical and biochemically silent, meaning it presented without typical symptoms or lab abnormalities.

Findings:

• Despite increased immunosuppressive therapy (corticosteroids and azathioprine), a biochemically silent pancreatitis developed.
• The silent pancreatitis was not diagnosed in a timely manner.
• The patient ultimately died from multisystem organ failure attributed to the undiagnosed pancreatitis.

Implications:

• This case highlights the potential for clinically and biochemically silent pancreatitis as a severe complication in SLE patients.
• It underscores the importance of considering pancreatitis in SLE patients, even in the absence of typical symptoms or biochemical markers.
• Radiological assessment, such as CT, may be vital for diagnosing silent pancreatitis in this population.