ACUTE PANCREATITIS AS INITIAL PRESENTATION AND FLARE OF SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE SERIES

Abstract

Acute pancreatitis (AP) is an uncommon but potentially life-threatening manifestation of systemic lupus erythematosus (SLE), occurring in approximately 0.7–4% of patients. It may appear during times of illness activity or as the first sign of SLE, posing significant diagnostic and therapeutic challenges. Early recognition is essential because its management differs from that of pancreatitis caused by more common etiologies and often requires immunosuppressive therapy. We describe two female patients with SLE-associated AP presenting in distinct clinical contexts. The first was a 25-year-old woman with no prior autoimmune disease who presented with moderate AP. Following exclusion of common causes, the development of a malar rash, arthralgia, hypocomplementemia, increased antibodies against double-stranded DNA and positive antinuclear antibodies led to the diagnosis of SLE. Class III lupus nephritis was verified by a subsequent kidney biopsy. The second patient was a 35-year-old woman with established SLE who developed AP during a disease flare characterized by reduced complement levels, deteriorating articular and cutaneous symptoms, and increased anti-double stranded DNA titres. In both cases, imaging confirmed AP, alternative etiologies were systematically excluded, and treatment with corticosteroids and immunosuppressive therapy resulted in clinical and biochemical improvement. SLE associated pancreatitis may happen during an aggressive disease flare-up or as the disease's first symptom. When patients have unexplained AP, especially when there are suggestive clinical or serological signs, clinicians should keep a high index of suspicion for SLE. To maximise results and detect concomitant organ involvement, prompt immunosuppressive treatment and careful monitoring are crucial.