Acute pancreatitis as an initial presentation of systemic lupus erythematosus: a case report

Systemic lupus erythematosus is a systemic autoimmune disease affecting different organ systems. Gastrointestinal symptoms in patients with systemic lupus erythematosus are common. But systemic lupus erythematosus-related acute pancreatitis is a rare presentation. Particularly, it is extremely rare to observe acute pancreatitis as the initial presentation of systemic lupus erythematosus combined with antiphospholipid syndrome.

Here, we report a case of abdominal pain as the initial symptom of systemic lupus erythematosus in a patient who was finally diagnosed with systemic lupus erythematosus-related acute pancreatitis. Our patient was a 47-year-old Han female with epigastric pain, nausea, vomiting gastric contents, and loss of appetite. She did not mention any relevant medical history and did not consume alcohol nor greasy food. She was successively diagnosed with acute cholecystitis, acute pancreatitis, and acute appendicitis, but relevant therapeutic interventions proved to be ineffective in improving gastrointestinal symptoms. Renal pathology, along with positive antinuclear antibody and anti-double stranded DNA tests, supported the diagnosis of systemic lupus erythematosus. In addition, the presence of positive anti-cardiolipin antibodies and lupus anti-coagulant, along with thrombosis in vein and internal carotid artery occlusion, supported the diagnosis of antiphospholipid syndrome. Corticosteroid and cyclophosphamide therapy led to resolution of abdominal manifestations, and the patient was discharged with methylprednisolone and hydroxychloroquine. Aspirin was used to treat antiphospholipid syndrome.

Systemic lupus erythematosus-related acute pancreatitis should be considered in the differential diagnosis of patients with acute pancreatitis after exclusion of other causes. The patient was given treatment as soon as possible. Corticosteroids combined with cyclophosphamide are an effective treatment.