Corticosteroid associated lupus pancreatitis

Area of Science:

• Internal Medicine
• Gastroenterology
• Rheumatology

Background:

• The link between glucocorticoid administration and acute pancreatitis is not well-established.
• Existing cases often involve confounding systemic vascular diseases like systemic lupus erythematosus (SLE).

Observation:

• A 22-year-old female diagnosed with SLE presented with eye involvement.
• She received pulse intravenous methylprednisolone followed by oral prednisolone.
• During treatment, she developed acute abdominal pain, distention, nausea, and vomiting, suggestive of peritonitis.

Findings:

• Abdominal CT scan showed perihepatic and perisplenic fluid with mesenteric heterogeneity.
• Exploratory laparotomy revealed diffuse abdominal fluid and pancreatic edema.
• Intra-abdominal fluid analysis showed elevated amylase and lipase levels.

Implications:

• Acute pancreatitis should be considered in the differential diagnosis of new-onset abdominal pain in patients undergoing pulse steroid therapy, even with normal serum amylase and lipase.
• This case highlights a potential adverse effect of glucocorticoids that requires clinical vigilance.
• Careful dose reduction of steroids may be necessary in such cases.