title: Auto-immune cholangiopathy in a juvenile patient with systemic lupus erythematosus.
abstract: Systemic lupus erythematosus (SLE) is a multi-system inflammatory disease characterized by the presence of auto-antibodies. Liver enzyme abnormalities are common but clinical liver dysfunction with jaundice is rare. We report a juvenile female patient with SLE who developed jaundice 9 months after her initial presentation. Further investigations including liver biopsy and magnetic resonance cholangio-pancreatography revealed two likely pathologies for her liver dysfunction; amoxicillin-clavulanic acid induced cholestasis and auto-immune cholangiopathy. The hyperbilirubinaemia resolved spontaneously 3 months after exposure to amoxicillin-clavulanic acid; however, the elevation in Alanine transaminase and Gamma-glutamyl transpeptidase persisted until intensive immunosuppressive therapy achieved complete remission.
  
  
  CONCLUSIONS
  We report a rare case of a juvenile patient with SLE and auto-immune cholangiopathy. The use of cholangio-pancreatography as part of the diagnostic work-up achieved the final diagnosis.
authors.affiliation: Departments of Paediatric Gastroenterology, Hepatology & Nutrition, Adult Renal Medicine and Histopathology at Addenbrookes NHS Trust, Cambridge University Hospitals, UK. gabriele.noble-jamieson@addenbrookes.nhs.uk
authors.forename: Gabriele
authors.initials: G
authors.lastname: Noble-Jamieson
authors.forename: David
authors.initials: D
authors.lastname: Jayne
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hook
mesh_terms: D000293:Adolescent; D001327:Autoimmune Diseases / Q000209:etiology*; D001649:Bile Duct Diseases / Q000276:immunology*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*