ACUTE LETHAL NECROTIZING PANCREATITIS IN CHILDHOOD SYSTEMIC LUPUS-ERYTHEMATOSUS - POSSIBLE TOXICITY OF IMMUNOSUPPRESSIVE THERAPY

We report on a 16 year old girl with a three-year history of systemic lupus erythematosus who developed a case of acute lethal haemorrhagic pancrentitis. She presented with high grade fever, skirt rash malaise, and arthralgias. Laboratory lupus activity parameters were markedly e levated. In the absence of renal, pulmonary, cardiac or cerebral invol vement, our patient developed pancreatitis leading to pancreatogenic s hock. Until 14 days before the onset of pancreatitis, the patient's me dications included prednisolone, azathioprine and methotrexate. At aut opsy, no autoimmune vasculitis was found in the affected pancreatic ti ssue. Therefor-e, an etiologic role of combination therapy had to be c onsidered. Whereas methotrexate has never been reported to be linked t o pancreatitis, a few publications describing prednisolone and azathio prine in connection with pancreatitis do exist. Thus, if pancreatitis is not just termed idiopathic, it must be attributed to a combination regimen of drugs including methotrexate. A review of the literature sh ows that pancreatitis in SLE is rare and has never been associated wit h methotrexate therapy before.