Lupus pancreatitis: A case series of 6 patients

Purpose: The onset of acute pancreatitis in systemic lupus erythematosus (SLE) is known but rare, and exceptionally revealing. Its pathogenesis is multifactorial, it is extremely difficult to separate what belongs to vasculitis, thrombotic phenomena in the context of antiphospholipid syndrome, or iatrogenic complications or intercurrent. We present six cases of lupus pancreatitis and discuss the difficulty of diagnosis. Methods: A retrospective monocenter study of 110 patients with systemic lupus erythematosus. The diagnosis of lupus pancreatitis was established after exclusion of other causes of pancreatitis. Results: Pancreatitis was noted in 6 patients (5.4%). There were five female and one male patients; the mean age of these patients was 36.3 years. In four patients pancreatitis was concurrent with the diagnosis of SLE and it occurred later during an exacerbation of the disease in the two remaining patients. In all patients, pancreatic manifestations were associated with other organ involvement. Clinical manifestations were: abdominal pain (n = 6), vomiting (n = 3) and fever (n = 3). Elevated pancreatic enzyme was noted in all cases. All patients were treated by high doses of glucocorticoids. The outcome was favorable in 5 patients, and one patient died. Conclusion: Most cases of lupus pancreatitis have been described in patients with multiple organ involvement. It is important to recognize the etiology of pancreatitis in the course of SLE (drug, lupus, gallstones...) because the therapeutic depends on it.