Acute liver failure as the first feature of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. Although gastrointestinal (GI) involvement is reported in the literature, GI manifestations of lupus are not common in the early disease course. GI symptoms can be related to several factors other than lupus; however, systemic lupus per se can be the responsible factor. Although the typical presentation is a gradual onset of progressive symptoms, acute abdominal pain is frequently reported and is the most serious presentation. It can reflect gastroenteritis, cholecystitis, hepatitis, pancreatitis, peritonitis, and abdominal vasculitis. When SLE diagnostic criteria for GI manifestations are lacking, the decision to implicate lupus as the cause of these manifestations is difficult, especially in the primary presentation. Early diagnosis and the initiation of immunosuppressive agents are associated with a better outcome. In this case, we introduce a patient who presented with acute abdominal pain secondary to acute liver failure as the first manifestation of lupus.