{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T19:56:11Z","timestamp":1772999771469,"version":"3.50.1"},"reference-count":17,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>A 14\u2010year\u2010old female with juvenile systemic lupus erythematosus (jSLE) presented with a life\u2010threatening 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\u2010titer GADA, IA\u20102A, and ZnT8A autoantibodies. This case provides a rare clinical model of a \u201cperfect storm\u201d in which a systemic inflammatory crisis appears to have inflicted widespread vasculitic injury while simultaneously acting as a \u201csecond hit\u201d to trigger a latent, organ\u2010specific autoimmunity. Aggressive immunosuppression with pulse corticosteroids and mycophenolate mofetil led to remission of this multi\u2010fronted immunological attack. This case expands the phenotypic spectrum of jSLE to include a new paradigm of \u201clupus crisis,\u201d demonstrating that a single flare can catastrophically shatter the boundaries between systemic and organ\u2010specific autoimmune diseases. It mandates a high index of suspicion for concurrent, multi\u2010lineage autoimmunity in patients presenting with severe, hyperinflammatory jSLE.<\/jats:p>","DOI":"10.1002\/ccr3.71968","type":"journal-article","created":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T05:44:04Z","timestamp":1769838244000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Unprecedented Triad: Simultaneous Acute Pancreatitis, Axonal Polyneuropathy, and Type 1 Diabetes Mellitus in a Catastrophic Juvenile Lupus Flare"],"prefix":"10.1002","volume":"14","author":[{"given":"Laiba","family":"Hashmi","sequence":"first","affiliation":[{"name":"Foundation University Medical College  Islamabad Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fazeela","family":"Bibi","sequence":"additional","affiliation":[{"name":"Jinnah Medical and Dental College  Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kishan Chand","family":"Lohana","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6138-6684","authenticated-orcid":false,"given":"Khalil","family":"El Abdi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy of Rabat Mohammed V University  Rabat Morocco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9053-2179","authenticated-orcid":false,"given":"Zonaira","family":"Mushahid","sequence":"additional","affiliation":[{"name":"Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5420-3749","authenticated-orcid":false,"given":"Muhammad Asad","family":"Asif","sequence":"additional","affiliation":[{"name":"Rawalpindi Medical College  Rawalpindi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahnoor","family":"Ilyas","sequence":"additional","affiliation":[{"name":"Women Medical College  Abbottabad Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0252-275X","authenticated-orcid":false,"given":"Osvani","family":"Leyva Matos","sequence":"additional","affiliation":[{"name":"American University of the Caribbean School of Medicine  Philipsburg Sint Maarten"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariba","family":"Munam","sequence":"additional","affiliation":[{"name":"Isra University  Hyder\u00e2b\u00e2d Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Saad","family":"Sammi","sequence":"additional","affiliation":[{"name":"United Medical &amp; Dental College  Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samaha Kanden Mohammed","family":"Shafi","sequence":"additional","affiliation":[{"name":"University of Sharjah  Charjah UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7885-6214","authenticated-orcid":false,"given":"Said Hamid","family":"Sadat","sequence":"additional","affiliation":[{"name":"Kabul University of Medical Science Abu Ali Ibn Sina  Kabul Afghanistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clim.2019.108274"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-021-00985-0"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203307087875"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24091"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203310378863"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43166\u2010022\u201000141\u20101"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2010.148221"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/children10050852"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1546\u20100096\u20108\u201010"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203307078074"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075\u2010024\u201003265\u20101"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296\u2010019\u201004388\u20104"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.610585"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42269\u2010020\u201000352\u20106"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1479\u20105876\u20108\u2010S1\u2010P73"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/mco2.70262"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41392\u2010024\u201001952\u20108"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71968","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.71968","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71968","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T17:22:26Z","timestamp":1772990546000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.71968"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,30]]},"references-count":17,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/ccr3.71968"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.71968","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,30]]},"assertion":[{"value":"2025-09-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71968"}}