Hyperlipidemic acute pancreatitis: a possible role of antiretroviral therapy with entecavir.
In most cases clinical profile of acute hyperlipidemic pancreatitis is a preexisting lipoprotein abnormality associated to second risk factors such as alcohol abuse, diabetes mellitus or medications that can induce hypertrygliceridemia. We report a case of a young male affected by chronic hepatitis B virus infection admitted to Emergency Department due to acute abdominal pain, vomiting and fever. The patient was in antiretroviral treatment with entecavir; moreover he was affected by diabetes mellitus and he presented a past history of alcohol abuse. Laboratory tests demonstrated hyperglycemia, severe metabolic acidosis and hypertriglyceridemia, whereas abdominal computed tomography scan revealed peripancreatic edema: hyperlipidemic pancreatitits was supposed and the patient was admitted to the intensive care unit. Considering its possible role in the pathogenesis of pancreatitis, entecavir was interrupted and total of 3 sections of plasmapheresis were performed, allowing clinical resolution and prevention of pancreatic damage. The possible pathogenetic role of entecavir is discussed.
Anesthesia and Intensive Care Unit, Misericordia e Dolce Hospital, Prato, Italy. siviglia5@alice.it
A
A
Durval
L
L
Zamidei
D
D
Bettocchi
M G
MG
Luzzio
G
G
Consales
D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000437:Alcoholism / Q000150:complications; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D003422:Critical Care; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005334:Fever / Q000209:etiology; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D015228:Hypertriglyceridemia / Q000150:complications; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use; D010195:Pancreatitis / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D010956:Plasmapheresis; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D000068698:Tenofovir; D014057:Tomography, X-Ray Computed; D014280:Triglycerides / Q000097:blood
D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D014280:Triglycerides; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D000225:Adenine