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Pancreatitis in SLE — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromePancreatitis in SLESCE Rheumatology

A 40-year-old woman with systemic lupus erythematosus develops acute pancreatitis. Azathioprine was started 3 weeks ago, while her prednisolone dose of 7.5 mg daily has been unchanged for 6 months. She reports minimal alcohol consumption, abdominal ultrasonography shows no gallstones or biliary dilatation, and serum calcium and triglycerides are normal. Her SLE is clinically and serologically quiescent. What is the most likely cause of her pancreatitis?

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Correct answer: D — Azathioprine-induced pancreatitis

The most likely diagnosis is azathioprine-induced pancreatitis. Azathioprine has a well-established causal association with acute pancreatitis, and the onset shortly after treatment initiation provides the key temporal clue. Its UK SmPC lists pancreatitis as an uncommon adverse effect. Gallstones, significant alcohol exposure, hypercalcaemia and hypertriglyceridaemia have been made unlikely by the stem. SLE-associated pancreatitis remains an important differential but is uncommon, usually accompanies active or multiorgan lupus, and is a diagnosis made after excluding alternative causes. Prednisolone-associated pancreatitis has been reported, particularly after recent initiation or escalation of medium-to-high doses; an unchanged low dose for 6 months makes this substantially less likely. Occult microlithiasis remains possible clinically but is not the single best explanation here.

Reference: Electronic Medicines Compendium. Azathioprine tablets 50 mg, Summary of Product Characteristics, section 4.8 Undesirable effects, updated 2026. https://www.medicines.org.uk/emc/product/14296/smpc