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Acute Pancreatitis in Hepatitis a Infection

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Acute Pancreatitis in Hepatitis a Infection Postgraduate Medical Journal (1986) 62, 407-408 Postgrad Med J: first published as 10.1136/pgmj.62.727.407 on 1 May 1986. Downloaded from Acute pancreatitis in hepatitis A infection A. Lopez Morante, C. Rodriguez de Lope, G. San Miguel and F. Pons Romero Gastroenterology Unit 'Marques de Valdecilla' Medical Center, Faculty ofMedicine, Santander, Spain. Summary: Hepatitis viruses are an uncommon cause of acute pancreatitis. We present the case of a boy with acute pancreatitis complicating viral hepatitis with satisfactory recovery. The finding of IgM- anti HAV antibodies implicates hepatitis A virus as the cause. Introduction Several viral infections have been implicated as 2208 U/I (normal 20-40); alkaline phosphatase: aetiological factors of acute pancreatitis. The viruses 350 U/I (normal 38-85). The plasma electrolytes, most frequently thought to be responsible are mumps creatinine, calcium, proteins and lipids were normal virus (Feldstein et al., 1974; Naficy et al., 1973), apart from an IgM of 515mg/dl (normal 35-56). Coxsackie B virus (Capner et al., 1975; Ursing, 1973; Hepatitis B surface antigen (HBsAg) was negative; Tsui et al., 1972), Epstein-Barr virus (Wislocki, 1968), IgM antibodies to HAV were positive (RIA Abbot). and measles virus (Bunnel & Monif, 1972). An associa- The serum isoamylases were studied by electro- tion between viral hepatitis and acute pancreatitis has phoresis and there was a single peak caused by amylase also been observed, although most of the patients P1. The 24-hour urinary amylase content was concerned had fulminating hepatitis and the causal 27,600 U and the amylase/creatinine clearance ratio agent has been identified in only a very few patients was 7.1% (normal < 5%). copyright. (Archod, 1968; Parbhoo et al., 1973; Wands et al., Plain films of abdomen showed distended small 1973). bowel loops with no fluid levels. Ultrasonographic We present here a patient with acute pancreatitis examination of the abdomen showed a layer of ascitic associated with acute hepatitis caused by hepatitis A fluid at the base ofthe lesser sac. The pancreatic region virus (HAV), who made a satisfactory recovery. could not be visualized because ofinterference by gas. Gall-bladder and bile duct were normal. Treatment was with fluid and electrolyte re- Case report placement. Pain ceased after one day and intestinal http://pmj.bmj.com/ movement returned two days after. On discharge, AST A 12 year old boy with no previous medical history, was 170 U/1, ALT 483 U/1, bilirubin and amylase became ill 8 days before admission with tiredness, returned to normal values. Ten days after discharge general malaise and dark urine. He was admitted to the AST and ALT values were normal, and a new the Emergency Department because of severe epigas- ultrasonographic examination showed a normal pan- tric pain of abrupt onset accompanied by nausea and creatic region and no ascitic fluid. vomiting. On admission, he was afebrile and jaun- diced. His abdomen was distended with general ten- on September 25, 2021 by guest. Protected derness on palpation and no bowel sounds were heard. Discussion The liver was enlarged 1 cm below the right margin. Laboratory investigations included: white blood The mechanism ofpancreatic damage by viruses is not count 12.8 x 109/l (81% polymorphs), haemoglobin known. The cytopathic effect may be direct or it may 16.3 g/dl, erythrocyte sedimentation rate 25 mm/h, be mediated through the patient's immune response. It serum amylase: 1200 U/dl (Somogyi) (normal < 180); has also been suggested that viral infections cause bilirubin: 7.3 mg/dl (normal 0.2-1.2) (conjugated oedema of Vater's ampulla and pancreatic ducts 3.3 mg/dl); aspartate aminotransferase (AST) 2100 U/l leading to pancreatitis as result of obstruction to the (normal 20-40); alanine aminotransferase (ALT) flow of pancreatic fluid (Tsui et al., 1972). When acute pancreatitis is associated with fulminat- Correspondence: F. Pons Romero, M.D., Residencia Piquio ing hepatitis, the virus may cause tissue damage 4 - 10 Dcha, Santander, Spain. directly, but there are several other factors which can Accepted: 22 October 1985 play an important role in the development of pan- C) The Fellowship of Postgraduate Medicine, 1986 408 CLINICAL REPORTS Postgrad Med J: first published as 10.1136/pgmj.62.727.407 on 1 May 1986. Downloaded from creatitis and these include acute liver failure, hypoten- hepatitis B virus core in the cytoplasm of pancreatic sion and drug induced disease. These factors were not acinar cells in patients infected with this virus. Pan- operative in our patient and so the pancreatic damage creatic lesions may be caused by immunological could only have been caused by HAV. mechanisms in a similar way to that in hepatocellular Shimoda et al. (1980) demonstrated the presence of necrosis. References ARCHOD, J.L. (1968). Acute pancreatitis with infectious pancreatitis with fulminant hepatic failure. Gut, 14, 428. hepatitis. Journal of the American Medical Association, SHIMODA, T., SHIKATA, T., ABE, K., TSUKAKOSHI, S., 205, 837. YOSHIMURA, S. & SAKURAI, I. (1980). Affinity of BUNNELL, C.E. & MONIF, G.R.F. (1972). Interstitial pan- hepatitis B virus for pancreatic tissue. Gastroenterology, creatitis in the congenital rubella syndrome. Journal of 79, 1124. Pediatrics, 80, 465. TSUI, C.H., BURCH, G.E. & HARB, J.M. (1972). Pancreatitis in CAPNER, P., LENDRUM, R., JEFFRIES, D.J. & WALKER, G. mice infected with Coxsackie virus B1. Archives of Path- (1975). Viral antibody studies in pancreatic disease. Gut, ology, 93, 379. 16, 866. URSING, B. (1973). Acute pancreatitis in Coxsackie B FELDSTEIN, J.D., JOHNSON, F.R., KALLICK, C.H.A. & infection. British Medical Journal, 3, 524. DOOLAS, A. (1974). Acute hemorrhagic pancreatitis and WANDS, J.R., SALYER, D.C., BOITNOTT, J.K. & MADDREY, pseudocyst due to mumps. Annals of Surgery, 180, 85. W.C. (1973). Fulminant hepatitis complicated by pan- NAFICY, K., NATEGH, R. & GHADIMI, H. (1973). Mumps creatitis. Johns Hopkins Medical Journal, 3, 156. pancreatitis without parotitis. British Medical Journal, 1, WISLOCKI, L.C. (1968). Acute pancreatitis in infectious 529. mononucleosis. New England Journal of Medicine, 275, PARBHOO, S.P., WELCH, J. & SHERLOCK, S. (1973). Acute 322. copyright. http://pmj.bmj.com/ on September 25, 2021 by guest. Protected.
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