Acute Pancreatitis with Normal Amylase/Lipase Levels? A Rare Case Study in Pakistan, an unusual manifestation of cystic fibrosis

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Acute Pancreatitis (AP) is the inflammation and auto-digestion of the pancreas and is usually associated with the elevation of serum amylase and lipase levels. Here, we report a rare presentation of AP with normal pancreatic enzymes and lupus vulgaris (LV) in a patient with cystic fibrosis (CF). The chief complaints included severe abdominal pain in association with fever and vomiting. On examination, the abdomen was tense and tender. There were bilateral coarse crepitations with expiratory wheeze more pronounced on the left lower chest. After detailed clinical evaluation, a provisional diagnosis of acute pancreatitis, with pneumonitis and oral thrush was established. Routine laboratory investigations were performed to confirm the diagnosis. However, the serum amylase and lipase came out within the normal reference range. So, computerized tomography (CT) scan of the abdomen was performed which showed a diffusely swollen and edematous pancreas along with peri-pancreatic stranding, and hence confirmed the diagnosis. Afterward, the patient was managed conservatively and he had an uneventful recovery. The purpose of reporting this case is to promote awareness among fellow healthcare professionals about this rare manifestation of AP and to prevent any missed diagnosis and serious complications. To conclude, cystic fibrosis may have an unusual presentation like AP without pancreatic enzyme elevation which may create a diagnostic dilemma. Hence, in such cases, a strong clinical suspicion and supportive radiological findings play a critical role in the establishment of the diagnosis.