Hepatic Manifestations in Systemic Lupus Erythematosus (SLE) and Cholestatic Hepatitis as Rare Initial Presentation: A Diagnostic Challenge

Document Type : Case Reports

Authors

1 Professor, Medicine, Ad-din Women’s Medical College Hospital, Dhaka, Bangladesh.

2 Registrar, Gastroenterology, Bangladesh Specialized Hospital.

Abstract

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease with various clinical manifestations. However, hepatic dysfunction is not included in the diagnostic criteria for the disease and has not been appropriately recognized. Abnormal liver tests are common (60%) at some point in Systemic Lupus Erythematosus (SLE) illness.  The spectrum of hepatic involvement described in these patients ranges from abnormalities in liver function tests (LFTs) to fulminant hepatic failure. Usually, abnormalities in LFTs are only mild and transient, have a hepatocellular pattern, and are not related to SLE but instead are primarily drug-related. In rare cases, severe cholestasis may invite diagnostic dilemmas. The most frequent finding on liver biopsy is steatosis (non-alcoholic fatty liver disease). Patients do not frequently progress to advanced chronic liver disease, and their outcome is favorable. Those who develop cirrhosis have traditional risk factors, such as other non-SLE-related conditions. We report a case of systemic lupus erythematosus presenting as cholestatic hepatitis in a 36-year-old Bangladeshi woman. The cholestatic hepatitis progressed as part of the lupus activity and responded to steroid therapy.
 

Keywords

Footnotes. Ahmed Agrodey (professor of gastroenterology, hepatology, and infectious diseases) and Sara Salem (lecturer of internal medicine) were the peer reviewers. E- Editor: Salem Youssef Mohamed, Osama Ahmed Khalil, Amany Mohammed. Copyright ©. This open-access article is distributed under the Creative Commons Attribution License (CC BY). It may be used, distributed, or reproduced in other forums, provided the original author(s) and the copyright owner(s) are credited. The original publication in this journal must be cited according to accepted academic practice. Disclaimer: The authors' claims in this article are solely their own and do not necessarily represent their affiliated organizations or those of the publisher, the editors, and the reviewers. Any product evaluated in this article or its manufacturer's claim is not guaranteed or endorsed by the publisher. Ethical approval: All procedures involving human participants followed the institutional and national research committee's moral standards, the 1964 Helsinki Declaration, and its later amendments or comparable ethical standards. All authors declare that consent was obtained from the patient (or other approved parties) to publish this study. Data and materials availability: The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This study had no funding from any resource. This work was done according to the CARE guidelines. Authors’ contributions: Richmond R Gomes and Rebeka Razzaque formulated the research concept, while Richmond R Gomes and Rebeka Razzaque conducted the clinical examinations and monitored the patients. Richmond R Gomes and Rebeka Razzaque collaborated to gather the necessary laboratory data. All authors actively participated in analyzing and interpreting the patient information and composing the manuscript. All authors thoroughly reviewed and approved the final version of the manuscript. Acknowledgments unremarkable. Conflict of interest: None declared

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