Acute pancreatitis preceding an acute episode of thrombotic microangiopathy.
Thrombotic microangiopathy (TMA) is a rarely reported complication of acute pancreatitis. The prognosis is generally good, if diagnosis is made early and treatment is adequate. We present the case of a 74-year-old man who visited our emergency department due to acute abdominal pain. He had no history of alcohol abuse or pancreatitis. Blood tests indicated elevated lipase and amylase. An abdominal computerized tomography (CT) indicated mild pancreatitis. After admission, the patient suffered a seizure and developed anemia, thrombocytopenia, elevated lactic dehydrogenase (LDH) and elevated unconjugated bilirubin. A peripheral blood smear indicated fragmented red blood cells. We diagnosed the patient as having TMA. After plasma exchange and plasma infusion therapy, the LDH and platelet levels gradually improved. A differential diagnosis of disseminated intravascular coagulation (DIC) and TMA following pancreatitis is necessary because of the different treatment strategies. Our patient had a good prognosis following therapy for TMA. Such therapy may include plasma exchange, plasma infusion, corticosteroid therapy and splenectomy.
Chang
H-H
HH
Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Chen
M L
ML
Chang
C-C
CC
D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D017707:Erythrocyte Transfusion / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D010951:Plasma Exchange / Q000379:methods; D057049:Thrombotic Microangiopathies / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed