Hypertriglyceridemic pancreatitis in infant with erysipelas

Abstract

Erysipelas most commonly affects infants and young children but sepsis in erysipelas is uncommon accounting for less than 1% [1]. Few authors have reported hypertriglyceridemia (HTGA) secondary to sepsis in children [2]. Moreover, HTGA is one cause of acute pancreatitis (AP): Bai et al. [3] have shown the metabolic causes of AP in approximately 2-7% of children. It is well known that sepsis and HTGA are independent risk factors for AP and this study will try to establish an association with HTGA secondary to sepsis and AP.A 40-day-old girl born full-term by means of C-section with uneventful pregnancy, normal for gestational age, breast-fed, was admitted to the pediatric operative unit with fever [39.81C (103.71F)]. On arrival, her physical examination was unremarkable except for the presence of facial and thoracic fiery-red plaques with raised, welldemarcated borders, local signs of inflammation and skin discomfort; vital signs, and hemogasanalysis were normal. The complete blood count showed high white blood cell count with marked neutrophilia (white blood cell 23.44 Â 10 9 /l, 18.752 neutrophils) and mild thrombocytosis (platelet count 637 Â 10 9 /l); erythrocyte sedimentation rate was 87 mm/h, C-reactive protein was 410 mg/l, and procalcitonin was 5.21 ng/ml. Blood culture was positive for Streptococcus pyogenes. Hydration, intravenous third generation cephalosporin, and antipyretic medications were effective at lowering the temperature and reducing plaques. During sixth hospital day, the laboratory work showed a fasting lactescent (milky) blood sample with HTGA (1565 mg/dl), extremely elevated low-density lipoprotein (LDL) levels (254 mg/dl), and very low high-density lipoprotein (HDL) levels (13 mg/ dl). Moreover lipase was 554 U/l and amylase was 134 U/l, whereas total cholesterol and liver functions were normal. The girl presented only with abdominal pain and tenderness and abdominal ultrasound shows a normal pancreas.Family history of lipid abnormalities was negative; lipase and amylase levels rapidly fell within 5 days of presentation whereas triglyceride (TG), LDL, HDL, levels were normalized about 5 months after pediatric operative unit admission.In erysipelas, the blood culture is positive in only 5% of cases and less common complication is septicemia [1,4]. Few studies have explored the metabolic response to sepsis in children: Henter et al.[2] reported TG and LDL levels markedly elevated and HDL decreased; Vermont et al.[5] noted extremely low levels of total cholesterol, HDL, and LDL in the initial phase of sepsis inversely associated with disease severity. Our findings are the same described by Henter et al. and emphasize the usefulness of TG levels as indicators of inflammatory activity. Both hereditary and secondary disorders of lipoprotein metabolism may be associated with hypertriglyceridemic pancreatitis (HTGP) but the mechanism by which HTGA causes AP is unknown. Because no official pediatric recommendations exist, the purpose of this letter is to bring to attention the importance of manage...

An erysipelas in a woman with pancreatitis

“…Sepsis during erysipelas is a rare complication of less than 1%. It is well known that sepsis and hypertriglyceridemia are independent risk factors for pancreatitis [2]. The mechanism by which hypertriglyceridemia causes pancreatitis is unknown.…”