Elevated Amylase and Lipase Mimicking Pancreatitis: Diagnostic Pitfall

Abstract

Purpose: Introduction: Serum amylase and lipase levels are standard tests to diagnose acute pancreatitis. However, they can be elevated in various clinical settings, including acute gastroenteritis or chronic alcoholism. Recognition is particularly important because using an elevated amylase or lipase level to diagnose acute pancreatitis may not be appropriate. We herein present a case of elevated amylase and lipase levels in the absence of acute pancreatitis. Case Presentation: A 56-year-old male with chronic alcoholism presented with nausea and vomiting for 5 days. He denied abdominal pain, fever or diarrhea. His past medical history was insignificant. He admitted alcohol abuse, notably hard liquors, which constituted his major dietary intake. His vital signs were T 96.9F, HR 90 /min, BP 142/91 mmHg, SpO2 97% on room air. He appeared disheveled. His heart sounds were regular and lungs were clear to auscultation. His abdomen was soft, bowel sounds were diminished but no tenderness was present. His complete blood count and metabolic panel were normal. His liver panel showed a slightly elevated ALT level of 90 U/L with normal bilirubin, ALP and ALT level. Serum amylase and lipase level was found to be 216 mg/dL and 702 mg/dL respectively. His alcohol level was 404 mg/dL. Ultrasonography showed fatty infiltration in the liver with intact pancreas, spleen and gallbladder. Subsequent esophagogastroduodenoscopy (EGD) revealed nonerosive gastritis. He was treated with intravenous fluids and esomeprazole. The following day, amylase and lipase level went down to 123 mg/dL and 437 mg/dL respectively. Discussion: Serum amylase or lipase levels are recognized as a useful marker for pancreatic inflammation. However, there are several other conditions that can cause hyperamylasemia or hyperlipasemia, such as gut perforation and renal failure. In this case, elevated amylase and lipase was probably due to acute gastritis and chronic alcoholism, considering the totally benign abdominal examination as well as the EGD findings. Although gastroenteritis in not widely considered as a cause of hyperamylasemia or hyperlipasemia, numerous cases have reported with possible specific pathogenesis. It may result from pancreatic involvement in the inflammatory process or from increased absorption of pancreatic enzymes from the intestinal lumen. Also, according to the literature, elevated serum lipase levels have been found in 11 to 33% of asymptomatic alcoholics. Therefore, acute gastroenteritis and chronic alcoholism should be included in the differential diagnosis of hyperamylasemia or hyperlipasemia. Extra caution should be exercised when interpreting elevated amylase and lipase mimicking pancreatitis.