Gastrointestinal system manifestations in juvenile systemic lupus erythematosus

Clin Rheumatol. 2017 Jul;36(7):1521-1526. doi: 10.1007/s10067-017-3571-3. Epub 2017 Feb 16.


Systemic lupus erythematosus (SLE) is an autoimmune disease which may involve gastrointestinal system (GIS). The aim of this study was to present GIS manifestations of pediatric SLE patients. The medical files of 69 children with SLE followed between January 2011 and January 2016 were reviewed. All fulfilled the Systemic Lupus International Collaborating Clinics criteria. All patients (≤18 years of age) with GIS manifestations were included. GIS manifestations were observed in 19 (27.5%) out of 69 SLE patients and present at the time of SLE diagnosis in 13 (68.4%). The GIS manifestations due to SLE were autoimmune hepatitis (AIH) (n = 8) and lupus enteritis (n = 1). Manifestations associated with SLE were hepatomegaly and hypertransaminasemia due to macrophage activation syndrome (MAS) (n = 3) and hepatic steatosis (n = 1). GIS manifestations as a result of the adverse events of drugs were as follows: toxic hepatitis (n = 3; associated with methotrexate and nonsteroidal anti-inflammatory drugs in one, methotrexate in another, and azathioprine in another patient), azathioprine-induced cholestatic hepatitis (n = 1), and gastritis associated with corticosteroid (n = 1). In one patient, acute appendicitis occurred as a coincidence. In this study, one of every five pediatric SLE patients had GIS-related manifestations. GIS involvement may occur as an initial manifestation of the disease.

Keywords: Autoimmune hepatitis; Child; Gastrointestinal system; Systemic lupus erythematosus.

MeSH terms

  • Adolescent
  • Antirheumatic Agents / adverse effects
  • Chemical and Drug Induced Liver Injury / etiology
  • Child
  • Child, Preschool
  • Enteritis / etiology*
  • Enteritis / physiopathology
  • Fatty Liver / etiology*
  • Fatty Liver / physiopathology
  • Female
  • Hepatitis, Autoimmune / etiology*
  • Hepatitis, Autoimmune / physiopathology
  • Hepatomegaly / etiology*
  • Hepatomegaly / physiopathology
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / physiopathology
  • Male


  • Antirheumatic Agents
  • Immunosuppressive Agents