# An Unprecedented Triad: Simultaneous Acute Pancreatitis, Axonal Polyneuropathy, and Type 1 Diabetes Mellitus in a Catastrophic Juvenile Lupus Flare

## TL;DR

A 14-year-old with lupus experienced a rare, severe flare involving pancreatitis, nerve damage, and diabetes, highlighting the need for vigilance in similar cases.

## Contribution

This case reports the first documented simultaneous occurrence of acute pancreatitis, axonal polyneuropathy, and Type 1 Diabetes in juvenile lupus.

## Key findings

- A hyperinflammatory lupus flare triggered widespread vasculitic injury and organ-specific autoimmunity.
- Aggressive immunosuppression successfully treated the multi-system autoimmune crisis.
- The case expands the known phenotypic spectrum of juvenile systemic lupus erythematosus.

## Abstract

A 14‐year‐old female with juvenile systemic lupus erythematosus (jSLE) presented with a life‐threatening and previously unreported triad: the simultaneous onset of acute pancreatitis, severe axonal polyneuropathy, and autoimmune Type 1 Diabetes (T1D). This catastrophic, polysyndromic flare was driven by a hyperinflammatory state consistent with Macrophage Activation Syndrome, with the T1D diagnosis confirmed by high‐titer GADA, IA‐2A, and ZnT8A autoantibodies. This case provides a rare clinical model of a “perfect storm” in which a systemic inflammatory crisis appears to have inflicted widespread vasculitic injury while simultaneously acting as a “second hit” to trigger a latent, organ‐specific autoimmunity. Aggressive immunosuppression with pulse corticosteroids and mycophenolate mofetil led to remission of this multi‐fronted immunological attack. This case expands the phenotypic spectrum of jSLE to include a new paradigm of “lupus crisis,” demonstrating that a single flare can catastrophically shatter the boundaries between systemic and organ‐specific autoimmune diseases. It mandates a high index of suspicion for concurrent, multi‐lineage autoimmunity in patients presenting with severe, hyperinflammatory jSLE.

A severe juvenile systemic lupus erythematosus (jSLE) flare can manifest as a catastrophic crisis with the unprecedented simultaneous onset of acute pancreatitis, axonal polyneuropathy, and autoimmune Type 1 Diabetes. This case mandates a high index of suspicion for concurrent, life‐threatening complications in severely ill jSLE patients.