Catherine Bioteau

ACUTE PANCREATITIS WITH NORMAL LIPASE IN AN 80-YEAR-OLD MAN

CASE REPORT An 80-year-old man with a history of arterial hypertension and type II diabetes mellitus was hospitalized for recurrent falls. On the second day of his stay, an episode of vomiting associated with moderate diffuse abdominal pain occurred. He had no fever, the abdomen was soft and diffusely tender, and he showed signs of cardiac insufficiency and delirium. There was no evidence of pneumonia or urinary tract infection. Electrocardiogram was normal. Laboratory tests showed lipase 21 IU/L (normal range 73–193 IU/L), amylase 22 IU/L (normal range 32–104 IU/L), aspartate aminotransferase 75 IU/L (normal range 15–37 IU/L), alanine aminotransferase 52 IU/L (normal range 12–78 IU/L), alkaline phosphatase 348 IU/L (normal range 50–136 IU/L), blood urea nitrogen 8.5 mg/dL (normal range 2.0–4.0 mg/ dL), creatinine 2.8 mg/dL (normal range 0.7–1.2 mg/dL), white blood cell 18,300 cells/mL (normal range 4,000– 11,000 cells/mL), neutrophils 94%, C-reactive protein (CRP) 390 mg/L (normal range 1–10 mg/L), procalcitonin 5.69 mg/L, (normal range 0.01–0.50 mg/L), troponin T 0.4 mg/L, (normal range 0.01–0.045 mg/L), partial pressure of oxyten 57 mmHg (normal range 79–109 mmHg), partial pressure of carbon dioxide 42 mmHg (normal range 37.6–42.1 mmHg), and pH 7.50 (normal range 7.35–7.45). Looking for an abdominal origin of infection, an abdominal–pelvic computed tomography (CT) scan was performed (Figure 1), which revealed acute pancreatitis (Balthazar grade C) with lithiasis in the biliary ducts. The Ranson score was calculated at 4. The clinical course was rapidly favorable under adequate medical treatment and after therapeutic endoscopic retrograde cholangiopancreatography (ERCP) on day 14. No alteration of lipase or amylase was found before ERCP. The patient was discharged after 10 days and admitted to the rehabilitation unit.