ECE2017 Eposter Presentations: Diabetes, Obesity and Metabolism Cardiovascular Endocrinology and Lipid Metabolism (29 abstracts)
Dyslipidemia-associated skin lesions as a short key for etiology unraveling and management of life-threatening acute pancreatitis in young male
Zoran Gluvić 1 , Bojan Mitrović 1 , Vladimir Samardžić 1 , Jelena Tica Jevtić 1 , Marina Vujović 1 , Vesna Popović-Radinović 1 , Aleksandar Stanojević 2 & Esma R. Isenović 3
1Division of Internal Medicine, Department of Endocrinology, Zemun Clinical Hospital, School of Medicine, University of Belgrade, Zemun, Serbia; 2Division of Internal medicine, Department of Gastroenterology, Zemun Clinical Hospital, School of Medicine, University of Belgrade, Zemun, Serbia; 3Laboratory for Molecular Endocrinology and Radiobiology, Institute for Nuclear Sciences ‘Vinča’, University of Belgrade, Belgrade, Serbia.
Background: After the gall bladder stones and alcohol abuse, dyslipidemia is among most frequent causes of acute pancreatitis, especially in youngsters. Some clinical signs can be useful to alleviate either a medical condition diagnosis confirmation or unraveling of its etiology.
Aim: We present a case 30 years old male, presented with nausea, vomiting and diffuse abdominal pain. Three months before hospital admission, patient was unsuccessfully treated for painful, reddish skin lesions 5mm in diameter, dispersed on abdominal wall, arms and legs, interpreted as ‘viral papillomata’. Out of mentioned skin lesions-eruptive xanthomata, hypotension, light abdominal tenderness and moderate distention, other physical examination was normal.
Results: Laboratory findings revealed lipemic serum, elevated inflammatory, pancreas and liver necrosis markers, hyperglycemia, hyponatremia and hypocalcaemia. Performed imaging procedures (ultrasound and computed tomography) showed enlarged pancreatic body and tail, and left pleural effusion. Lipemic serum and eruptive xanthomata taken together with other case findings pointed to life-threatening acute pancreatitis caused by mixed dyslipidemia, obviously serious (lipids could not be measured initially). In association with aggressive pancreatitis management, nil-by-mouth treatment with plasmapheresis successfully lowered lipids and enabled their measurement (triglycerides 19.9 mmol/l and cholesterol 10.8 mmol/l). After plasmapheresis, diet and fibrate, triglycerides and cholesterol levels were 4.04 and 3.99 mmol/l, respectively. Patient was referred to lipid clinic, gastroenterologist and surgeon (formed pancreatic cyst).
Conclusions: Adequately interpreted eruptive xanthomata can act as a shortkey for faster confirmation of acute pancreatitis. Treatment of serious pancreatitis and dyslipidaemia is done at the same time. Plasmapheresis, as well lifelong diet and pharmacotherapy later, are the mainstay for management of dyslipidaemia that caused pancreatitis (presumably mixed one).
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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