Pancreatic panniculitis in active systemic lupus erythematosus

Area of Science:

• Rheumatology
• Dermatology
• Nephrology

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
• End-stage renal disease (ESRD) is a common complication of SLE, often requiring dialysis.
• Pancreatic panniculitis is a rare form of panniculitis associated with pancreatic disease.

Observation:

• A 64-year-old African-American female presented with new-onset ESRD and SLE, confirmed by biopsy and serologies.
• The patient developed tender nodules on her shins, diagnosed as pancreatic panniculitis via biopsy.
• Elevated lipase and amylase levels were noted, but imaging ruled out pancreatitis or pancreatic tumors.

Findings:

• The biopsy revealed fat necrosis with "ghost cells" and granular debris, characteristic of pancreatic panniculitis.
• The patient's presentation, including lupus nephritis and pancreatic panniculitis, is similar to a recently reported case.
• This suggests a potential association between SLE, particularly lupus nephritis in African-American women on dialysis, and pancreatic panniculitis.

Implications:

• This case underscores the importance of considering pancreatic panniculitis in SLE patients presenting with subcutaneous nodules.
• Identifying this specific subset of SLE patients may allow for earlier diagnosis and management of pancreatic complications.
• Further research is warranted to elucidate the underlying mechanisms and confirm the increased risk in this population.