A Case of HIV and Abdominal Pain

Amal Chakkor, MD and Rachida Saouab, MD

July 1, 2017

A 41-year-old African female with human immunodeficiency virus infection (CD4 cell count, 200/mm³) presented to the emergency department with a 3-day history of epigastric pain and non-bloody, non-bilious emesis. She was taking lamivudine (3TC) (150 mg twice daily) for 5 years and had no previous opportunistic infections. She denied a history of alcohol or illicit drug use.  She had history of cholecystectomy for acalculous cholecystitis six years ago, but denied any similar clinical episode to her current presentation. 

Physical examination demonstrated epigastric tenderness with no organomegaly. Her blood analysis results were as follows: serum lipase level was 315 IU/L  (lipase upper limit of normal: 75 IU/L), C-reactive protein was 15 mg/L, and white blood cell count was 3800/mm³. Her fasting plasma glucose test was elevated at 190 mg/L and liver-function tests were unremarkable. 

Computed tomographic (CT) contrast-enhanced scan of the abdomen revealed multiple parenchymal and intraductal dense calcifications (1400 UH) with secondary dilatation of the main pancreatic duct (MPD) of 13 mm, associated with atrophy of the pancreas (See Figure 1). The CT oblique reconstruction further demonstrated multiple intraductal calcifications and a dilated MPD (See Figure 2). In addition, a peripancreatic fat stranding was seen around the pancreatic tail, consistent with mild acute pancreatitis grade C (CT Severity Index 2) revealing chronic calcific pancreatitis.

The patient's epigastric pain resolved within 7 days with conservative therapy. Lamivudine was discontinued and subsequently, lipase levels declined. 

References:

1.  Ueda T, Takeyama Y, Yasuda T, Shinzeki M, Sawa H, Nakajima T, et al. Immunosuppression in patients with severe acute pancreatitis. J Gastroenterol 2006; 41: 779-784.
2.  Montessori V, Press N, Harris M, Akagi L, Montaner JS. Adverse effects of antriretroviral therapy for HIV infection. CMAJ. 2004;170(2):229-38
3.  Riedel DJ, Gebo KA, Moore RD, Lucas GM. A ten-year analysis of the incidence and risk factors for acute pancreatitis requiring hospitalization in an urban HIV clinical cohort. AIDS Patient Care STDS 2008; 22(2): 113-121.

Author Information:  

Amal Chakkor is a 3rd year gastroenterology resident at Mohamed V University in Rabat, Morocco.
Rachida Saouab is a radiology professor at the Mohamed V Military Hospital in Rabat, Morocco.