Systemic lupus erythematosus (SLE) rarely causes pancreatitis and/or protein-leakage gastroenteropathy as a gastrointestinal (GI) manifestation. Here, we describe the incidental detection of SLE-associated pancreatitis by protein leakage scintigraphy.
A 19-year-old man presented to our outpatient department with fever, headache, and malaise. Laboratory tests showed erythrocythemia, hypoalbuminemia, low serum C3 and C4, and elevation of antinuclear antibody. With butterfly erythema and other clinical signs, the patient was diagnosed with SLE.
To rule out protein-losing gastroenteropathy (PLGE), we performed protein leakage scintigraphy (PLS) using 99mTc-human serum albumin diethylenetriamine pentaacetic acid (99mTc-HSAD) and single photon emission computed tomography/computed tomography (SPECT/CT). SPECT/CT revealed elevated radiotracer uptake not only in the GI tract but also in the pancreas (Figures 1A,B). Plain CT showed enlargement of the pancreas, suggestive of pancreatitis. Further blood tests revealed elevation of the serum levels of amylase and lipase.
(A) Pretherapeutic 99mTc-HSAD scintigram and (B) SPECT/CT revealed elevated pancreatic uptake (arrows) in addition to elevated gastrointestinal uptake reflecting protein-losing gastroenteropathy. After treatment, pancreatic 99mTc-HSAD uptake was no longer seen in either (C) scintigram or (D) SPECT/CT. 99mTc-HSAD: 99mTc-human serum albumin diethylenetriamine pentaacetic acid; SPECT/CT: single photon emission computed tomography/computed tomography.
Follow-up 99mTc-HSAD SPECT/CT was performed 48 days after the start of treatment. Abnormal uptakes in the GI tract and pancreas were no longer seen on PLS (Figures 1C,D). CT showed shrinkage of the pancreas.
To our knowledge, there are no reports that illustrated elevated 99mTc-HSAD uptake in the pancreas. Considering decreased pancreatic uptake alongside clinical improvement and pancreas shrinkage on CT, we believe that 99mTc-HSAD SPECT/CT could detect SLE-associated pancreatitis in our case. Dorraji et al reported 99mTc-albumin nanocolloid accumulation in the pancreas in SLE-prone mice due to tertiary lymphoid structures.1
In conclusion, when evaluating the PLS scans of patients with suspected or confirmed SLE, we should pay attention not only to the GI tract but also to other abdominal organs such as the pancreas.
Footnotes
H. Yamada and T. Sugiyama contributed equally to this work.
The authors declare no conflicts of interest relevant to this article. Institutional review board approval was not required for this case report according to the authors’ institution. Written consent to publish identifying information was obtained from the patient.
- Copyright © 2024 by the Journal of Rheumatology
DATA AVAILABILITY
Data available upon reasonable request to the corresponding author.
