Tropical calcific pancreatitis in HIV patient

Abstract

Sir,A 36-year-old female from rural central Maharashtra with known case of human immunodeficiency virus infection (CD4 cell count, 249 per cubic millimeter) for six months on regular anti retroviral drugs presented with epigastric pain, nausea, and few episodes of vomiting for 3 days. She was taking a combination of lamivudine and zidovudine (from local civil hospital where anti retroviral drugs are provided free of cost). There were similar episodes of such type of abdominal pain. Abdominal pain was mid epigastric, dull aching in nature, increased after taking meal and some times radiating to back. She was also diagnosed recently as insulin diabetes mellitus and taking regular insulin. She was a nonsmoker and nonalcoholic. We had no reports regarding investigations performed during previous episodes and had not identified other causes of pancreatitis. On examination, vitals were stable and tenderness was present in the epigastric region. There was no palpable abdominal mass or other specific findings noted on physical appearance. At the time of admission, hemoglobin was 7.9 g/dl, total leukocyte count was 4800 and platelet count was 431,000. Her fasting and post meal blood sugar were 180 and 220 mg per dl on regular insulin. Her serum lipase was 193 U per liter (normal range up to 180 U/litre). Serum amylase and lipase levels are widely used as screening tests for acute pancreatitis in patients with acute abdominal pain or back pain. Values greater than three times the upper limit of normal virtually clinch the diagnosis if gut perforation or infarction is excluded.