Objective

To explore the clinical diagnosis，treatment and prognosis of systemic lupus erythematosus （SLE）-related acute pancreatitis（AP）in children.

Methods

Twenty-four children with SLE-related AP admitted to West China Second University Hospital，Sichuan University from January 2018 to December 2024 were selected as the research subjects.AP was the initial presentation in 7 patients，and 17 patients were complicated by AP after the diagnosis of SLE.A retrospective study method was used to collect the general clinical data，clinical symptoms and signs，laboratory tests，imaging examinations，SLE disease activity index （SLEDAI），treatment and prognosis of all children.The procedures followed in this study were in line with the requirements of the newly revised World Medical Association Declaration of Helsinki in 2024.

Results

The results of clinical diagnosis，treatment and prognosis analysis of 24 children in this study were as follows.①General clinical data：Among the 24 cases of SLE-related AP children，the median age of SLE diagnosis was 12 years old，and there were 22 females （91.7%）.Severe AP accounted for 54.2%（13/24）.Common gastrointestinal manifestations included abdominal pain in 21 cases（87.5%），nausea and vomiting in 17 cases （70.8%），abdominal distension in 11 cases （45.8%），and upper abdominal tenderness in 19 cases （79.2%）.The SLEDAI score was 16-41 points.All had≥2 organs/systems involved，with acute kidney injury（AKI）in 16 cases （66.7%）and macrophage activation syndrome（MAS）in 4 cases （16.7%）.②Results of auxiliary examinations：Among the 24 cases of SLE-related AP children，the proportions of elevated serum amylase and（or）lipase，decreased serum Ca²⁺concentration，elevated triglyceride concentration were 20 cases（83.3%），22 cases（91.7%）and 20 cases （95.2%，20/21），respectively.Abnormal abdominal CT results were found in 20 children （83.3%）.Abdominal ultrasound was performed in 17 children，and abnormalities were found in 7 children （41.2%）.④Treatment and outcome：All 24 children received high-dose methylprednisolone pulse therapy，21 children were given immunosuppressants，and 18 children received plasma exchange therapy.After treatment，18 children （75.0%）achieved clinical remission and were discharged，six children （25.0%）died，all of whom were severe AP.The mortality rate of children with severe AP was 46.2%（6/13）.

Conclusions

Children with SLE-related AP has a similar clinical manifestation to AP children without SLE and occurs mostly in adolescent females，all of whom have active SLE with multiple organ system involvement.SLE-related severe AP is relatively common and has a high mortality rate.High-dose glucocorticoid therapy combined with immunosuppression and plasma exchange may lead to a better prognosis in children with SLErelated AP.