[Acute pancreatitis as first manifestation of systemic lupus erythematosus].

Background: Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with a broad clinical spectrum; gastrointestinal involvement can occur at any stage. SLE-associated pancreatitis is infrequent and exceptional as an initial manifestation, but it is associated with high morbidity and mortality. The objective was to describe a case of severe acute pancreatitis as the initial presentation of SLE and highlight its diagnostic and prognostic relevance. Case report: A 22-year-old female with no significant medical history and a history of inflammatory arthralgia was admitted for intense abdominal pain and intractable vomiting. Acute pancreatitis was documented, progressing to severe necrotizing pancreatitis (Balthazar E), complicated by respiratory failure and admission to the intensive care unit. Given the absence of common risk factors and the presence of hemolytic anemia, a thorough immunological workup was performed, confirming autoimmunity with positive antinuclear and anti-dsDNA antibodies, diagnosing de novo SLE. Patient received high doses of corticosteroid treatment and immunosuppressive therapy, with a favorable clinical outcome. Conclusions: Lupus pancreatitis is a marker of high systemic activity and severity, often underestimated by indices such as SLEDAI. Its timely recognition is fundamental to optimize the prognosis, requiring a multidisciplinary approach with early intensive support and immunosuppressive treatment.