Lupus-related advanced liver involvement as the initial presentation of systemic lupus erythematosus.
OBJECTIVE
Systemic lupus erythematosus (SLE), a prototype of systemic autoimmune disease characterized by multiorgan involvement with diverse clinical and serological manifestations, principally affects women in their child-bearing years. Clinically significant hepatic abnormality as the initial presentation of SLE has rarely been reported.


METHODS
Eleven patients with lupus with initial presentation of lupus-related hepatitis were included in this retrospective review. Clinical manifestation, immunological profiles, and risk factors for poor prognosis were analyzed.


RESULTS
The most commonly associated clinical manifestations were found to be thrombocytopenia, leukopenia, advancing age, and presence of anti-SSA/Ro antibody and anti-thyroid antibodies. The diagnosis of SLE was delayed due to dominant hepatic abnormalities. Age greater than 50 years and marked hepatic decompensation in accordance with Child classification B and C might suggest poor prognosis (p=0.06). However, the p value was not statistically significant because of the small sample size.


CONCLUSIONS
Lupus-related hepatitis, particularly in late-onset lupus, is common. In addition, the presence of anti-SSA, anti-thyroglobulin, and anti-microsomal antibodies is indicative of hepatic involvement in patients with SLE.
Lu
Ming-Chi
MC
Division of Immunology, Rheumatology and Allergy, DaLin Tzu Chi Buddhist Hospital, Chia-Yi, Taiwan.
Li
Ko-Jen
KJ
Hsieh
Song-Chou
SC
Wu
Cheng-Han
CH
Yu
Chia-Li
CL
D000328:Adult; D000368:Aged; D000375:Aging; D000906:Antibodies / Q000097:blood; D001323:Autoantibodies; D001324:Autoantigens / Q000276:immunology; D005260:Female; D006505:Hepatitis / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007970:Leukopenia / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000209:etiology*; D008177:Lupus Vulgaris / Q000150:complications*; D008297:Male; D008875:Middle Aged; D020733:RNA, Small Cytoplasmic / Q000276:immunology; D012189:Retrospective Studies; D012261:Ribonucleoproteins / Q000276:immunology; D013921:Thrombocytopenia / Q000473:pathology; D013961:Thyroid Gland / Q000276:immunology; D000099207:SS-A Antigen
D000906:Antibodies; D001323:Autoantibodies; D001324:Autoantigens; D020733:RNA, Small Cytoplasmic; D012261:Ribonucleoproteins; C116006:RO60 protein, human; D000099207:SS-A Antigen; C006606:anti-thyroglobulin