An Unusual Case of Acute Pancreatitis Associated With Acute Hepatitis E Virus Infection

Abstract

The coincidence of viral hepatitis and acute pancreatitis is well described. Most of the cases are related to acute hepatitis A or B; however, pancreatitis due to Hepatitis E Virus (HEV) infections are rare. Most cases of acute pancreatitis is associated with fulminant viral hepatitis; however, acute pancreatitis occurring in non-fulminant hepatitis is less commonly documented. The case presented here describes moderate pancreatitis in a young male, manifesting during the course of a non-fulminant acute hepatitis E infection. KEYWORDSAcute Pancreatitis, Hepatitis E, Fulminant, Non-Fulminant. In spite of its rarity, the physician should remain alert to the possibility of pancreatitis in a patient of acute hepatitis E. Symptoms such as severe abdominal pain, restlessness or shock must warrant a search for underlying pancreatitis. It is important to recognise it at an early stage, as early constitution of treatment can help prevent the mortality associated with pancreatitis. HOW TO CITE THIS ARTICLE: CASE REPORTA 21-year-male presented to the emergency in Patna Medical College with a history of severe abdominal pain and restlessness for two days. He was apparently well fifteen days back; he then complained of yellowish discoloration of urine followed by the sclera. Associated symptoms included anorexia, nausea, low-grade fever and arthralgia. He was taking advice from a local physician for these complaints with no improvement in symptoms. The day before admission in our hospital, he complained of severe epigastric pain which exacerbated on lying down and on taking meals. The pain was severe in intensity and did not respond to over-the-counter analgesics. The next day he felt restless and complained of diaphoresis and was rushed to our emergency. At the time of admission, he was restless and perspiring excessively. His pulse rate was 120/minute and he had a Blood Pressure of 70/40 mmHg. General examination revealed icterus with a greenish tinge and mild pallor. Abdominal examination revealed generalised tenderness and guarding over the epigastric area. No organs were palpable and the liver span was normal. Chest examination was normal. The cardiovascular examination was normal, but for tachycardia. Financial or Other, Competing Interest: None. Submission 27-07-2016, Peer Review 24-08-2016, Acceptance 30-08-2016, Published 08-09-2016. Corresponding Author: Dr. Kumar Himanshu, Junior Resident, Department of Medicine, Patna Medical College, Patna. E-mail: rgtc2008@gmail.com DOI: 10.14260/jemds/2016/1206 Nervous system examination did not show any abnormality. The patient had never consumed alcohol, had never suffered from cholelithiasis or related diseases, had no history of any significant drug intake or any surgical procedures or history of any abdominal trauma, nor had he ever suffered from chronic medical illnesses such as Diabetes or Hypertension or Dyslipidaemia. His family history did not reveal anything significant.A presumptive diagnosis of Acute Hepatitis complicated by Pancreatitis was made ...

Pancreatitis Associated with Viral Hepatitis: Systematic Review

“…However, 8 case studies and case series, in which individual data for each patient were not available, were excluded from the analyses. As a result, 46 studies reporting data on 73 patients were included [ 7 , 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ].…”