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Analysis of 15 patients with abnormal liver function as the first systemic lupus erythematosus symptom.

OBJECTIVE
To understand the clinical characteristics of patients with abnormal liver function as the first symptom of systemic lupus erythematosus (SLE).


METHODS
Here, 15 patients admitted to a hospital from January 2010 to December 2013 with initial presentation of lupus-related hepatitis or cirrhosis were included. Their SLE-DAI scores and clinical and laboratory data were collected. All cases received liver protection therapy and active SLE controlling treatment with methylprednisolone combined with rapamycin.


RESULTS
When hepatic abnormalities were the most prominent feature during the first visit, the patient was more likely to receive an incorrect diagnosis or be diagnosed with SLE late. Of the 15 cases, only 7 (46.7%) were identified as SLE within a week of presentation of abnormal liver function ; meanwhile, the 7 remaining patients (46.7%) were not correctly diagnosed until more than 2 weeks later and as late as 4 months ; in addition, 1 patient was not diagnosed with SLE until 8 years after the initial presentation of abnormal liver function. In the 3-month follow-up after active treatment, liver function was completely restored in 10 cases with no cirrhosis and significantly improved in 3 patients who still had cirrhosis. Another case showed no improvement in liver function and was self-discharged, and another died from chronic liver failure.


CONCLUSION
Liver injury caused by SLE is not uncommon, and it is easy to tentatively diagnose it as hepatitis, delaying the correct diagnosis of SLE. In such patients, physicians should perform a thorough differential diagnosis as soon as possible and administer proper treatment. Corticosteroid conjugated with immunosuppressants with no or little liver toxicity would be suitable for patients with SLE-induced liver injury. (Acta gastroenterol. belg., 2016, 79, 441-446).