Plasmaférese como modalidade terapêutica na pancreatite aguda por hipertrigliceridemia / Plasmapheresis as a therapeutic approach for hypertriglyceridemia-induced acute pancreatitis

RESUMO

Pancreatite aguda é uma condição inflamatória manifestada clinicamente por dor abdominal e níveis séricos elevados das enzimas pancreáticas. A hipertrigliceridemia é sua terceira causa mais comum. O presente relato teve por objetivo descrever um caso de pancreatite aguda por hipertrigliceridemia, cuja modalidade terapêutica utilizada foi a plasmaférese. Paciente, gênero feminino, 48 anos, apresentou-se ao hospital com queixa de "dor muito forte na barriga". Relatou início do quadro com náuseas, vômitos e dor abdominal do tipo queimação, iniciada em região epigástrica. Negou febre. Ao exame: obesa, orientada, taquipneica, normotensa, taquicárdica, normocorada, desidratada, afebril, anictérica, acianótica; abdome: distendido, ruídos hidroaéreos presentes, timpânico, doloroso difusamente, porém, principalmente em andar supramesocólico. Aos exames de admissão: triglicerídeo 10.932 mg/dL, colesterol 1.548 mg/dL, amilase 226 mg/dL, lípase 899 mg/dL. A tomografia computadorizada de abdome evidenciou pâncreas aumentado de volume (Balthazar E). Evoluiu com piora do estado geral, sendo encaminhada para o centro de terapia intensiva. Foi realizada plasmaférese sem intercorrências. No 14º dia, teve alta do centro de terapia intensiva indo para enfermaria de gastrenterologia, onde foi reiniciada dieta oral, com boa aceitação. Evoluiu bem, com alta hospitalar no 25º de internação. São necessários níveis elevados de triglicerídeos para causar pancreatite, sendo importante excluir causas mais comuns. A abordagem terapêutica utilizada foi importante para reduzir, rapidamente, a hipertrigliceridemia elevada, evitando, assim, danos tissulares maiores.

ABSTRACT

Acute pancreatitis is an inflammatory condition that is clinically manifested by abdominal pain and elevated serum levels of pancreatic enzymes. Hypertriglyceridemia is the third most common cause of acute pancreatitis. The present report aimed to describe a case of hypertriglyceridemia-induced acute pancreatitis, where the therapeutic approach was plasmapheresis. A 48-year-old female patient was admitted to the hospital with complaints of "severe abdominal pain". She reported the onset of such symptoms as nausea, vomiting and abdominal pain with a burning feeling in the epigastric area. The patient denied having a fever. The initial examination revealed that she was obese, oriented, tachypneic, normotensive, tachycardic, dehydrated, afebrile, anicteric and acyanotic and had normal color. Her abdomen was distended with bowel sounds, tympanic and diffusely painful, which was mostly in the supramesocolic compartment. The initial laboratory exams showed 10.932 mg/dL triglycerides, 1.548 mg/dL cholesterol, 226 mg/dL amylase and 899 mg/dL lipase. The abdominal computed tomography exhibited increased pancreatic volume (Balthazar E). The patient's condition worsened, and she was sent to the intensive care center. Plasmapheresis was performed with no complications. On the 14th day after admission, the patient was discharged from the intensive care center and was sent to the gastroenterology ward, where an oral diet was resumed with good acceptance. The patient progressed well and was discharged from the hospital on the 25th day after admission. High triglyceride levels are necessary to cause pancreatitis, and it is important to exclude the most common causes. Importantly, the therapeutic approach reduced the high hypertriglyceridemia quickly, thereby avoiding tissue damage.