Timing clinical events in the treatment of pancreatitis and hypertriglyceridemia with therapeutic plasmapheresis

Abstract

Background Hyperlipidemic pancreatitis (HP) is caused by severe hypertriglyceridemia (SHTG). Evidence of SHTG refractoriness to standard medical treatment but not to therapeutic apheresis has increased in the last years. Methods Described is the timing of clinical events and the sequence of therapeutic plasma-exchange (TPE) procedures to treat pancreatitis due to SHTG in a male patient, Caucasian, aged 49 years, referred to emergency for severe epigastric pain. There was no history of alcohol consumption, a pre-existing mild hyperlipidemia was treated with diet alone, and biliary imaging was normal. Physical examination revealed epigastric tenderness. Laboratory investigation revealed marked hypertriglyceridemia (11,355 mg/dL; range: 30–150), and hypercholesterolemia (941 mg/dL; range: 80–200). Serum amylase (Amy) and lipase (Lip) were increased: 160 UI/L (range: 20–100) and 175 UI/L (range: 13–60), respectively. A computerized tomography (CT) scan of the abdomen revealed a picture compatible with acute pancreatic phlogosis. It was diagnosed as “acute secondary pancreatitis (AP) and SHTG”. Results The patient was successfully submitted to three sessions of TPE in emergency. He was released from hospital after 13 days of hospitalization. The levels of lipids and lipoproteins in his plasma were as follows: triglycerides (TG) 185 mg/dL; total cholesterol (TC) 179 mg/dL; HDL-cholesterol (HDLC) 22 mg/dL; LDL-cholesterol (LDLC) 120 mg/dL. Conclusions The decision to submit the patient with clinical evidence of HP caused by SHTG to apheresis was correct. The improvement in the clinical picture was fast and the recovery was complete.