Hemophagocytic syndrome as a complication of acute pancreatitis: A case report

Abstract

Background: Haemophagocytic syndrome (HPS) is rarely seen in patients with acute pancreatitis (AP). HPS as a complication of AP in patients without any previous history has not been elucidated.

Case summary: A 46-year-old man was admitted for symptom of persistent abdominal pain, nausea, and vomiting for 2 d after heavy drinking. During hospital stay, he suddenly developed skin rash and a secondary fever. The laboratory findings revealed progressive pancytopenia, abnormal hepatic tests, and elevation of serum triglyceride, ferritin, and lactate dehydrogenase levels. However, apparent bacterial or viral infections were not detected. He was also possibly related to autoimmune diseases because of positive expression of various autoimmune antibodies and no remarkable past history. Finally, the bone marrow examination showed a histiocytic reactive growth and prominent hemophagocytosis, which resulted in a diagnosis of HPS. Unexpectedly, the patient responded well to the immunosuppressive therapy.

Conclusion: HPS is a very rare extrapancreatic manifestation of AP. The diagnosis relies on bone marrow examination and immunosuppressive therapy is effective. For AP with skin changes, the possibility of HPS should be considered during clinical work.

Keywords: Acute pancreatitis; Haemophagocytic syndrome; Immunosuppressive therapy.

Figure 1

Results of examinations. A: Detailed therapeutic measures taken for the patient with acute pancreatitis during the time of hospitalization. Nutrition support therapy included 5% glucose, compound sodium chloride, hetastarch, mix sugar electrolyte, fructose, compound amino acid peptide, glutamine dipeptide, multi-vitamin, and fish oil fat emulsion; B: Temperature change curve of the patient. The measuring frequency was four times a day; C: Jejunum nutrition tube was placed by gastroscopy; D-G: Changes of amylase, lipase, white blood cell count, C-reactive protein, erythrocyte sedimentation rate, and hemoglobin during hospitalization.

Figure 2

Images of abdominal computed tomography. A and B: Contrast-enhanced computed tomography imaging of the pancreas showed pancreatic swelling, peripancreatic infiltration, and bilateral fascia thickening on the fourth day of hospitalization; C and D: The pancreatic swelling and peripancreatic fluid collections were meliorated on day 13; E and F: The peripancreatic seepage almost recovered on day 23.

Figure 3

Images of thoracic computed tomography. A and B: On the fourth day, thoracic computed tomography showed bilateral pleural effusion with partially encapsulated effusion. The lungs also showed scattered linear and lamellar high-density shadows, which were considered to be due to an infectious disease; C and D: Thoracic computed tomography indicated that encapsulated effusion was gradually absorbed but the left lung showed segmental atelectasis on day 13; E and F: Bilateral pleural effusion completely disappeared and segmental atelectasis was recovered on day 23.

Figure 4

Changes of indexes after effective treatment. A-E: Changes of platelets and serum levels of alanine aminotransferase, aspartate amino transferase, triglyceride, ferritin, and lactic acid dehydrogenase during hospitalization; F: The patient suddenly developed skin rash; G: No obvious abnormality was found in the peripheral blood smear (original magnification, 1 × 10³); H: Overactive macrophage phagocytosis, erythrocytes, leucocytes, platelets, and their precursors were also not found in the bone marrow aspiration specimen (original magnification, 1 × 10³). ALT: Alanine aminotransferase; AST: Aspartate amino transferase.