Unveiling the Spectrum of Liver Endurance in Systemic Lupus Erythematosus: A Single-Center Experience From Kashmir, India

Background Systemic lupus erythematosus (SLE) presents myriad challenges to gastroenterologists, although clinically significant liver involvement is uncommon. Literature regarding liver involvement remains variable, and the scope to illuminate this issue is vast, necessitating further study. Aims and objectives The purpose of this study was to assess and categorize the liver involvement in SLE and to evaluate treatment response. Methods Our study was a retrospective observational study. Diagnosed cases of SLE referred to the Department of Gastroenterology were evaluated for liver involvement. Detailed history, clinical examination, and biochemical profile were recorded. Imaging, liver biopsy, and/or endoscopic gastroduodenoscopy were used as adjuncts wherever needed. After proper evaluation, patients were categorized according to liver involvement, and treatment response was assessed. Results Out of 96 patients with SLE referred to gastroenterology, 32 had liver abnormalities. Six (12.5%) patients had non-alcoholic fatty liver disease, four (12.5%) had nodular regenerative hyperplasia, two (6.25%) had lupus hepatitis, five (15.62%) had drug-induced liver injury, and one case each (3.12%) had hepatic infarction, hepatitis B, and hepatitis C. Autoimmune hepatitis (AIH) was seen in five (15.62%) patients, primary biliary cholangitis (PBC) was seen in one (3.12%), and AIH-PBC overlap was seen in three (9.375%) patients. Treatment was tailored according to the diagnosis, and response was assessed. One patient with hepatic infarction presenting as ALF died. Conclusion Liver perturbations may arise from basic diseases or side effects during treatment or unrelated factors. It is a multifaceted interplay between autoimmune mechanisms, vascular complications, and drug-related hepatotoxicity. Recognizing diverse presentations and understanding diagnostic intricacies are crucial for clinicians managing SLE patients with hepatic involvement, enabling better treatment outcomes.