Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine/National Clinical Research Center for Child Health, Hangzhou 310052, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2022 Aug 15;24(8):917-922. doi: 10.7499/j.issn.1008-8830.2203006.
A girl aged 12 years and 2 months presented with recurrent abdominal pain and vomiting for more than 2 years and arthrodynia for 3 months. She was diagnosed with recurrent acute pancreatitis with unknown causes and had been admitted multiple times. Laboratory tests showed recurrent significant increases in fasting serum triglyceride, with elevated immunoglobulin and positive antinuclear antibody. The girl was improved after symptomatic supportive treatment. The girl developed arthrodynia with movement disorders 3 months before, and proteinuria, hematuria, and positive anti-double-stranded DNA antibody were observed. The renal biopsy was performed, and the pathological examination and immunofluorescence assay suggested diffuse lupus nephritis (type Ⅳ). She was finally diagnosed with systemic lupus erythematosus (SLE), lupus nephritis (type Ⅳ), and recurrent acute pancreatitis. Pancreatitis was suspected to be highly associated with SLE. She was treated with oral hydroxychloroquine sulfate and intravenous methylprednisolone sodium succinate and cyclophosphamide. Arthrodynia was partially relieved. She was then switched to oral prednisone acetate tablets. Intravenous cyclophosphamide and pump infusion of belimumab were regularly administered. Now she had improvement in arthrodynia and still presented with proteinuria and hematuria. It is concluded that recurrent acute pancreatitis may be the first clinical presentation of SLE. For pancreatitis with unknown causes, related immunological parameters should be tested, and symptoms of the other systems should be closely monitored to avoid delaying the diagnosis.
一位 12 岁零 2 个月的女孩因反复发作性腹痛、呕吐 2 年余，关节痛 3 个月就诊。曾被诊断为不明原因的复发性急性胰腺炎，多次住院。实验室检查发现空腹血清甘油三酯持续显著升高，免疫球蛋白升高，抗核抗体阳性。经对症支持治疗后症状改善。3 个月前女孩出现关节痛伴运动障碍，同时出现蛋白尿、血尿和抗双链 DNA 抗体阳性。行肾活检，病理检查和免疫荧光检查提示弥漫性狼疮肾炎（Ⅳ型）。最终诊断为系统性红斑狼疮（SLE）、狼疮性肾炎（Ⅳ型）和复发性急性胰腺炎。胰腺炎高度怀疑与 SLE 相关。给予羟氯喹硫酸酯口服、甲泼尼龙琥珀酸钠静脉滴注和环磷酰胺静脉滴注治疗，关节痛部分缓解，后改为醋酸泼尼松龙片口服。定期静脉注射环磷酰胺和泵输注贝利尤单抗。现患者关节痛改善，但仍有蛋白尿和血尿。结论：复发性急性胰腺炎可能是 SLE 的首发临床表现。对于不明原因的胰腺炎，应检测相关免疫学参数，并密切监测其他系统的症状，以免延误诊断。
