Anisakis simplex ( A.s.) induced acute pancreatitis and hepatic involvement in gastroallergic anisakiasis

Abstract

Rationale A.s. produces allergic and gastrointestinal pathology. The main gastrointestinal symptom is epigastric pain produced by gastric reaction to the parasite. Methods Description of clinical, biochemical and allergological features in two patients with gastrointestinal anisakiasis and hepatopancreatic complications. Results Patient 1: Female. 50 years old. No hepatobiliary or gastrointestinal pathology. Twelve hours after the intake of raw anchovies she suffered epigastric pain radiating to the back. After diminishing, symptoms reappeared after 24 hours and ceased completely after 48 hours. Laboratory features: AST 345 (4-31), ALT 190 (5-41), LDH 715 (240-480), serum amylase 889 (30-110), urine amylase 3725 (32-641), with remarkable decrease in five days. Abdominal ultrasonography and CT scanning: neither cholelithiasis nor hepatopancreatic pathology. Prick-test with A.s. extract: positive. Total IgE 299 (after 9 months 142) kU/l, specific IgE 65,2 (22,6) kU/l, specific IgG4 1,251 (0,425) mg/l. Patient 2: Male. 50 years old. No hepatobiliary or gastroduodenal pathology. Thirty minutes after eating raw anchovies he suffered a generalized urticaria and epigastric pain with nausea. Abdominal pain disappeared within 24 hours. Laboratory features: serum amylase 202, urine amylase 2518, ALT 59 with remarkable decrease in two days. Prick-test with A.s. extract: positive. Total IgE 215 (after 9 months 153) kU/l, specific IgE 20,5 (9,2) kU/l, specific IgG4 26,463 mg/l. Conclusions Anisakis simplex produces complex gastrointestinal disorders in humans associated to gastric or gastroallergic anisakiasis. Hepatic and pancreatic pathology suggests extrahepatic biliary obstruction by edema in the sphincter of Oddi area in the context of an acute reaction caused by the parasite.