Hepatic Manifestations in Systemic Lupus Erythematosus (SLE) and Cholestatic Hepatitis as Rare Initial Presentation: A Diagnostic Challenge

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease with various clinical manifestations. However, hepatic dysfunction is not included in the diagnostic criteria for the disease and has not been appropriately recognized. Abnormal liver tests are common (60%) at some point in Systemic Lupus Erythematosus (SLE) illness. The spectrum of hepatic involvement described in these patients ranges from abnormalities in liver function tests (LFTs) to fulminant hepatic failure. Usually, abnormalities in LFTs are only mild and transient, have a hepatocellular pattern, and are not related to SLE but instead are primarily drug-related. In rare cases, severe cholestasis may invite diagnostic dilemmas. The most frequent finding on liver biopsy is steatosis (non-alcoholic fatty liver disease). Patients do not frequently progress to advanced chronic liver disease, and their outcome is favorable. Those who develop cirrhosis have traditional risk factors, such as other non-SLE-related conditions. We report a case of systemic lupus erythematosus presenting as cholestatic hepatitis in a 36-year-old Bangladeshi woman. The cholestatic hepatitis progressed as part of the lupus activity and responded to steroid therapy.