Eosinophilic Pancreatitis: A Rare Cause of Recurrent Acute Pancreatitis

Eosinophilic pancreatitis is a rare form of recurrent acute pancreatitis that demonstrates distinct histologic features, including diffuse, periductal, acinar, and septal inflammatory infiltrates comprised of a pure or predominant population of eosinophils, eosinophilic phlebitis and arteritis, and localized eosinophilic infiltrates with pseudocyst formation. It is associated with elevated serum immunoglobulin E levels, an elevated eosinophil count with systemic manifestations, and eosinophilic infiltrates in other organs of the gastrointestinal tract. We present a case of eosinophilic pancreatitis in a 44-year-old man who was diagnosed after pancreatic resection for recurrent bouts of acute pancreatitis. While the gross and histologic evaluations matched other reported cases of eosinophilic pancreatitis, our patient had only minimal peripheral eosinophilia, no reported history of symptoms related to elevated eosinophilia or immunoglobulin E, and only mild eosinophilic infiltrates in his gallbladder.

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The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis

Lipids in Health and Disease ◽

10.1186/s12944-021-01488-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Robert J. Sanchez ◽

Wenzhen Ge ◽

Wenhui Wei ◽

Manish P. Ponda ◽

Robert S. Rosenson

Keyword(s):

Acute Pancreatitis ◽

Medical Records ◽

Adult Population ◽

Baseline Period ◽

Prior History ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Recurrent Acute Pancreatitis ◽

History Of ◽

Nationally Representative

Abstract Background This retrospective cohort study assessed the annualized incidence rate (IR) of acute pancreatitis (AP) in a nationally representative US adult population, as well as the variation in the risk of AP events across strata of triglyceride (TG) levels. Methods Data were obtained from IQVIA’s US Ambulatory Electronic Medical Records (EMR) database linked with its LRxDx Open Claims database. Inclusion criteria included ≥1 serum TG value during the overlapping study period of the EMR and claims databases, ≥1 claim in the 12-month baseline period, and ≥ 1 claim in the 12 months post index. All TG measurements were assigned to the highest category reached: < 2.26, ≥2.26 to ≤5.65, > 5.65 to ≤9.94, > 9.94, and > 11.29 mmol/L (< 200, ≥200 to ≤500, > 500 to ≤880, > 880, and > 1000 mg/dL, respectively). The outcome of interest was AP, defined as a hospitalization event with AP as the principal diagnosis. Results In total, 7,119,195 patients met the inclusion/exclusion criteria, of whom 4158 (0.058%) had ≥1 AP events in the prior 12 months. Most patients (83%) had TGs < 2.26 mmol/L (< 200 mg/dL), while < 1% had TGs > 9.94 mmol/L (> 880 mg/dL). Overall, the IR of AP was low (0.08%; 95% confidence internal [CI], 0.08–0.08%), but increased with increasing TGs (0.08% in TGs < 2.26 mmol/L [< 200 mg/dL] to 1.21% in TGs > 11.29 mmol/L [> 1000 mg/dL]). In patients with a prior history of AP, the IR of AP increased dramatically; patients with ≥2 AP events at baseline had an IR of 29.98% (95% CI, 25.1–34.9%). Conclusion The risk of AP increases with increasing TG strata; however, the risk increases dramatically among patients with a recent history of AP.

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Primary Hyperparathyroidism due to Parathyroid adenoma presenting as recurrent acute pancreatitis

Asian Journal of Medical Sciences ◽

10.3126/ajms.v8i1.15985 ◽

2017 ◽

Vol 8 (1) ◽

pp. 98-100

Author(s):

Tarun J George ◽

Pughazhendhi Thangavelu ◽

S Zahir Hussain ◽

MP Kumaran ◽

Kini Ratnakar ◽

...

Keyword(s):

Acute Pancreatitis ◽

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Elevated Serum ◽

Surgical Excision ◽

Medical Sciences ◽

Thyroid Lobe ◽

Recurrent Acute Pancreatitis ◽

Hypoechoic Nodule ◽

Left Thyroid Lobe

Primary hyperparathyroidism (PHPT) due to parathyroid adenoma presenting as recurrent acute pancreatitis is a rare entity. A 17-year-old male presented with recurrent attacks of pancreatitis and was found to have elevated serum calcium and Parathyroid hormone levels, 11.9mg/dL (8.5-10.2 mg/dL) and 396 pg/ml (10-65pg/ml) respectively. USG neck showed a 1.1 x 0.9 cm hypoechoic nodule in the superior aspect of left thyroid lobe. Parathyroid scintigraphy findings were consistent with parathyroid adenoma. After recovery of pancreatitis, surgical excision of the adenoma was done and the histopathological findings confirmed parathyroid adenoma. There were no further recurrence of pancreatitis following the excision.Asian Journal of Medical Sciences Vol.8(1) 2017 98-100

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Colopancreatic Fistula: An Uncommon Complication of Recurrent Acute Pancreatitis

Case Reports in Gastrointestinal Medicine ◽

10.1155/2018/4521632 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Mouhanna Abu Ghanimeh ◽

Omar Abughanimeh ◽

Khalil Abuamr ◽

Osama Yousef ◽

Esmat Sadeddin

Keyword(s):

Acute Pancreatitis ◽

Alcohol Intake ◽

Definitive Treatment ◽

Watery Diarrhea ◽

Endoscopic Retrograde ◽

Recurrent Acute Pancreatitis ◽

History Of ◽

Acute And Chronic Pancreatitis ◽

Heavy Alcohol Intake ◽

Uncommon Complication

Colonic complications, including colopancreatic fistulas (CPFs), are uncommon after acute and chronic pancreatitis. However, they have been reported and are serious. CPFs are less likely to close spontaneously and are associated with a higher risk of complications. Therefore, more definitive treatment is required that includes surgical and endoscopic options. We present a case of a 62-year-old male patient with a history of heavy alcohol intake and recurrent acute pancreatitis who presented with a 6-month history of watery diarrhea and abdominal pain. His abdominal imaging showed a possible connection between the colon and the pancreas. A further multidisciplinary workup by the gastroenterology and surgery teams, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and colonoscopy, resulted in a diagnosis of CPF. A distal pancreatectomy and left hemicolectomy were performed, and the diagnosis of CPF was confirmed intraoperatively. The patient showed improvement afterward.

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Endoscopic sphincterotomy (ES) may not alter the natural history of idiopathic recurrent acute pancreatitis (IRAP)

Pancreatology ◽

10.1016/j.pan.2016.07.009 ◽

2016 ◽

Vol 16 (5) ◽

pp. 770-777 ◽

Cited By ~ 7

Author(s):

Rohit Das ◽

Bridger Clarke ◽

Gong Tang ◽

Georgios I. Papachristou ◽

David C. Whitcomb ◽

...

Keyword(s):

Acute Pancreatitis ◽

Natural History ◽

Endoscopic Sphincterotomy ◽

Recurrent Acute Pancreatitis ◽

History Of

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An Unexpected Result of Obesity Treatment: Orlistat-Related Acute Pancreatitis

Case Reports in Gastroenterology ◽

10.1159/000430433 ◽

2015 ◽

Vol 9 (2) ◽

pp. 152-155 ◽

Cited By ~ 11

Author(s):

Murat Kose ◽

Samim Emet ◽

Timur Selcuk Akpınar ◽

Mehmet Ilhan ◽

Ali Fuat Kaan Gok ◽

...

Keyword(s):

Acute Pancreatitis ◽

Elevated Serum ◽

Interesting Case ◽

Unexpected Result ◽

Fat Tissue ◽

Initial Stage ◽

Tissue Edema ◽

Edematous Pancreatitis ◽

Prevalence Of Obesity ◽

History Of

Orlistat is a pancreatic lipase inhibitor which is used to treat obesity. Due to the increasing prevalence of obesity, orlistat use is thought to rise progressively. We report an interesting case caused by orlistat use caught in the early stages of acute pancreatitis through imaging; in addition, the case had significantly elevated serum amylase levels. A 54-year-old male who had a history of orlistat treatment started 7 days before was admitted to the emergency department with complaints of abdominal pain, nausea and vomiting lasting for 24 h. Abdominal computed tomography revealed peripancreatic fat tissue edema and a heterogeneous appearance of the pancreas. Based on these findings, it was concluded that edematous pancreatitis was in its initial stage. Orlistat is a drug that is increasingly widespread use due to obesity. More attention must be paid when planning to prescribe orlistat to patients if there are risk factors for acute pancreatitis (alcohol use, height, serum calcium and lipid levels).

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Abdominal pain and a raised amylase? It’s not always pancreatitis…

Acute Medicine Journal ◽

10.52964/amja.0310 ◽

2013 ◽

Vol 12 (3) ◽

pp. 163-165

Author(s):

IO Oluwatowoju ◽

◽

EO Abu ◽

G Lawson ◽

◽

...

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

Epigastric Pain ◽

Elevated Serum ◽

High Serum ◽

Amylase Level ◽

Serum Amylase Level ◽

Heavy Alcohol ◽

Heavy Alcohol Consumption ◽

History Of

We report the case of a 72 year old man with a history of COPD and heavy alcohol consumption who was initially diagnosed with acute pancreatitis based on a presentation with epigastric pain and elevated serum amylase. Review of his notes revealed several previous similar admissions and extensive normal investigations apart from persistently elevated amylase. Further analysis showed evidence of macroamylasaemia which accounted for the apparently high serum amylase level.

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347 Endoscopic Sphincterotomy (ES) May Not Alter the Natural History of Idiopathic Recurrent Acute Pancreatitis (IRAP)

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.03.082 ◽

2016 ◽

Vol 83 (5) ◽

pp. AB142

Author(s):

Rohit Das ◽

Bridger Clarke ◽

Gong Tang ◽

Georgios I. Papachristou ◽

David C. Whitcomb ◽

...

Keyword(s):

Acute Pancreatitis ◽

Natural History ◽

Endoscopic Sphincterotomy ◽

Recurrent Acute Pancreatitis ◽

History Of

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Moderate Hypertriglyceridemia Causing Recurrent Pancreatitis: A Case Report and the Literature Review

Case Reports in Gastrointestinal Medicine ◽

10.1155/2018/8714390 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Vijay Gayam ◽

Amrendra Kumar Mandal ◽

Pavani Garlapati ◽

Mazin Khalid ◽

Arshpal Gill ◽

...

Keyword(s):

Acute Pancreatitis ◽

Insulin Infusion ◽

Term Treatment ◽

Recurrent Acute Pancreatitis ◽

Nasogastric Feeding ◽

Long Term Treatment ◽

History Of ◽

Laboratory Investigations ◽

Continuous Insulin Infusion

Recurrent acute pancreatitis secondary to hypertriglyceridemia (HTG) with levels below 1000 mg/dL has been rarely reported in the literature. HTG is the third most common cause of acute pancreatitis and has been established in the literature as a risk factor when levels are greater than 1000 mg/dL. A 43-year-old patient presented to the hospital with severe epigastric abdominal pain. Initial laboratory investigations were significant for a lipase level of 4143 U/L and a triglyceride level of 600 mg/dL. Computed tomography (CT) of the abdomen showed diffuse enlargement of the pancreas consistent with pancreatitis. A diagnosis of severe acute pancreatitis secondary to high triglycerides was made based on the revised Atlanta classification 2012. The patient was initially managed with intravenous boluses of normal saline followed by continuous insulin infusion. Diabetic Ketoacidosis (DKA) was ruled out due to a past medical history of diabetes. Her clinical course was complicated by acute respiratory distress syndrome requiring intubation and mechanical ventilation. During the course, she improved symptomatically and was extubated. She was started on nasogastric feeding initially and subsequently switched to oral diet as tolerated. After initial management of HTG with insulin infusion, oral gemfibrozil was started for long-term treatment of HTG. Emerging literature implicates HTG as an independent indicator of poor prognosis in acute pancreatitis (AP). Despite the paucity of data, the risk of developing AP must be considered even at triglyceride levels lower than 1000 mg/dL.

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Idiopathic Pancreatitis in a Patient with a STAT3 Mutation

Allergy & Rhinology ◽

10.2500/ar.2016.7.0148 ◽

2016 ◽

Vol 7 (1) ◽

pp. ar.2016.7.0148 ◽

Cited By ~ 1

Author(s):

Chelsea Michaud ◽

Brian Peppers ◽

John Frith ◽

Haig Tcheurekdjian ◽

Robert Hostoffer

Keyword(s):

Acute Pancreatitis ◽

Immunoglobulin E ◽

Necrotizing Pancreatitis ◽

Skin Infections ◽

Idiopathic Pancreatitis ◽

Genetic Ablation ◽

History Of ◽

Stat3 Mutation ◽

Stat3 Mutations ◽

Mammalian Protein

Background Hyperimmunoglobulin E syndrome (HIES) is a rare primary immunodeficiency characterized by recurrent skin infections with abscesses, recurrent pneumonias with pneumatoceles, and immunoglobulin E levels of >10 times the upper limit of normal. Case The patient described herein had a classic case of signal transducer and activator of transcription S (STAT3) deficiency associated with HIES diagnosed several years before this particular presentation. He demonstrated extraimmune manifestations of the disease as well, including characteristic facies and a history of skeletal fractures. In addition, the patient had several distinct episodes of idiopathic pancreatitis for which a full gastrointestinal workup had been performed. STAT3 mutation was confirmed by genotyping at the time of diagnosis of HIES. Conclusions STAT3, a mammalian protein that regulates cell growth, survival, and differentiation, has been linked to human pancreatic carcinogenesis as well as the above-mentioned immune deficiency. Mouse studies demonstrated that genetic ablation of STAT3 exacerbates the course of acute pancreatitis, whereas normal pancreatic STAT3 seems to have a protective effect against necrotizing pancreatitis. An association between STAT3 mutations and pancreatitis has not yet been revealed in humans. Here we describe a case of acute pancreatitis that presented in a patient with STAT3 mutation.

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