Acute pancreatitis in paediatric systemic lupus erythematosus

Acute pancreatitis ( AP) rarely complicates the clinical course of systemic lupus erythematosus ( SLE). AP as the initial manifestation of SLE is exceptional, but its outcome is often fatal. Corticosteroids have been suspected to play a role in the development of AP, but the therapeutic benefit seems to be far above the risk of exacerbation of pancreatic lesions. We report a 13-y-old girl presenting with arthralgia and malaise, followed by abdominal pain, generalized oedema and haemodynamic instability. Increased CRP ( 325 ng/ml), serum amylase ( 14 000 IU/l) and lipase ( 2500 IU/l) levels suggested AP. Acute anuric renal failure required haemodialysis. Multiorgan involvement suggested SLE, which was confirmed 3 d later by increased anti-ds- DNA levels. Three methylprednisolone pulses were administered promptly, followed by oral prednisone ( 1.5 mg/kg/d) and six pulses of cyclophosphamide ( 500 mg/1.73 m(2)/2 wk). Mycophenolate mofetil was introduced for long-term disease control. Amylase and lipase levels decreased over 4 wk. Renal function was normal after 3 wk and proteinuria negative after 6 wk. Conclusion: This case suggests that steroid pulse therapy should be promptly administered if clinical and biochemical investigations suggest SLE to be responsible for AP. Aggressive treatment may be life saving.