three times the upper limit of normal, and CT scan findings compatible with acute pancreatitis. 2 In the present case, diagnosis of acute pancreatitis was based on radiological findings. The decisive finding is the persistent normal lipase (and amylase) level throughout the course of a case of acute pancreatitis. Typically, during acute pancreatitis, the lipase level increases within the first 4 to 8 hours, reaches a peak at 24 hours and remains high for 1 to 2 weeks. Lipase is a highly sensitive and specific marker of pancreatic pathology, giving it a prominent place in the diagnosis of acute pancreatitis. 3 According to a recent systematic review, the negative predictive value of lipase varies between 94% and 100%, 4 but a normal lipase level cannot exclude the diagnosis of acute pancreatitis. Moreover, lipase level does not correlate with disease severity according to guidelines and studies. 5 This is the sixth case described in the literature. Of the previous case descriptions, two died, two were aged 80 and older, and four had diabetes mellitus. 6-8 False negatives for amylase were associated with a context of underlying chronic pancreatitis, an alcoholic home, and hypertriglyceridemia. 4 None of these situations played a role in the reported case; the possibility of a genetic polymorphism in these two enzymes could be discussed. Morphological examination of reference is the CT scan, which is recommended as part of the initial examination only in cases of diagnostic uncertainty but is used systematically after 48 hours to assess disease severity according to Balthazar score. 9 In summary, the diagnosis of acute pancreatitis cannot be excluded according to normal enzyme laboratory tests. Although exceptional, this needs to be taken into account in older adults, in whom atypical clinical presentation occurs frequently.

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