Abstract
A 26-year-old woman was admitted to our hospital because of edema, photo-sensitivity, and abdominal pain in July 2004. Laboratory findings showed proteinuria (20 g/day), decreased complements (CH50 3.7 U/ml, C3 18.4 mg/dl), positive anti-nuclear antibody, positive anti-ds-DNA antibody (161.9 IU/ml), and elevated levels of serum creatinine (1.44 mg/dl) and pancreatic Enzymes (: trypsin＞900 ng/ml, PST1 42 ng/ml, phospholipase A2 1110 ng/dl, esterase 618.0 ng/nl). Computed tomography of the abdomen showed a swollen pancreas, but did not show dilatation of the pancreatic duct. Magnetic resonance cholangio pancreatography showed the bile duct and pancreatic duct to be normal. She was diagnosed as having lupus nephritis and acute severe pancreatitis associated with systemic lupus erythematosus (SLE). She was treated with methylprednisolone pulse therapy (500 mg×3 days), prednisolone (60 mg/day), cyclophosphamide pulse therapy (total 1400 mg), gabexate mesilate (1000 mg/day) and ulinastatin (200000 U/day). Her pancreatitis was not caused by drugs such as prednisolone and immunosuppressive drugs and by other general factors. Her pancreatitis was improved concomitant with lupus symptoms. More than half of SLE patients have manifestations of the digestive organ system, but pancreatitis is rare. Although pancreatitis associated with SLE was reported to have poor prognosis, we got a good outcome in this patient with intensive immunosuppressive therapy.
