E39 Hepatocellular insufficiency and systemic lupus; what is the relationship?!!

Abstract

Abstract Introduction Systemic lupus erythematosus (SLE) can be associated with several nonspecific hepatic manifestations, but acute lupus hepatitis remains uncommon and rarely constitutes a revelation mode. Objectives To report a case of systemic lupus presented by hepatocellular insufficiency. Materials and methods The patient was eleven years old when admitted in 2017 for investigation of hepatocellular failure. Physical examination: mucocutaneous jaundice with dark urine without other abnormalities. The biological assessment revealed significant hepatic cytolysis, cholestasis, as well as a biological inflammatory syndrome, polyclonal hypergammaglobulinemia predominant on gamma globulins. Urinary sediment and blood count were normal. Ultrasound and hepatosplenic Doppler showed signs of chronic liver disease: portal hypertension and moderate ascites. Cardiac ultrasound showed pericardial effusion. We carried out an etiological assessment comprising: an exhaustive questioning having eliminated any drug or toxic intake. The serologies for viral hepatitis A, B and C were negative. The search for non-organ-specific anti-tissue antibodies (anti-smooth muscle, anti-mitochondria and anti-LKM1) were negative, as well as a cupric balance. Antinuclear antibody was positive with a titre of 1/1000, anti-DNA was positive (> 866 IU/ml), C3, C4 and CH50 were low, and antiphospholipid antibodies were positive. The diagnosis of systemic lupus erythematosus was made. The patient was on corticosteroid therapy and immunosuppressant. The evolution was marked by the progressive improvement of the hepatic balance sheet. Discussion Although hepatic involvement during SLE is not part of the diagnostic criteria, abnormal liver function tests are frequent, ranging from 23% to 60% depending on the series in the literature. However, SLE-specific liver disease or lupus hepatitis is rare, observed in 1% to3% according to the literature. Our patient was symptomatic with hepatocellular insufficiency. Conclusion Lupus hepatitis is a rare manifestation of SLE and constitutes a rare presenting mode that should not be overlooked. Ethics Associate Professor of pediatrics, department of medicine University Setif-Algeria (pediatric center –Setif-Algeria).