ABSTRACT
In most cases clinical profile of acute hyperlipidemic pancreatitis is a preexisting lipoprotein abnormality associated to second risk factors such as alcohol abuse, diabetes mellitus or medications that can induce hypertrygliceridemia. We report a case of a young male affected by chronic hepatitis B virus infection admitted to Emergency Department due to acute abdominal pain, vomiting and fever. The patient was in antiretroviral treatment with entecavir; moreover he was affected by diabetes mellitus and he presented a past history of alcohol abuse. Laboratory tests demonstrated hyperglycemia, severe metabolic acidosis and hypertriglyceridemia, whereas abdominal computed tomography scan revealed peripancreatic edema: hyperlipidemic pancreatitits was supposed and the patient was admitted to the intensive care unit. Considering its possible role in the pathogenesis of pancreatitis, entecavir was interrupted and total of 3 sections of plasmapheresis were performed, allowing clinical resolution and prevention of pancreatic damage. The possible pathogenetic role of entecavir is discussed.
Subject(s)
Antiretroviral Therapy, Highly Active/adverse effects , Guanine/analogs & derivatives , Hyperlipidemias/chemically induced , Pancreatitis/chemically induced , Abdominal Pain/etiology , Acute Disease , Adenine/analogs & derivatives , Adenine/therapeutic use , Adult , Alcoholism/complications , Critical Care , Diabetes Mellitus, Type 2/complications , Fever/etiology , Guanine/adverse effects , Guanine/therapeutic use , Hepatitis B, Chronic/complications , Hepatitis B, Chronic/drug therapy , Humans , Hyperlipidemias/blood , Hyperlipidemias/diagnosis , Hypertriglyceridemia/complications , Male , Organophosphonates/therapeutic use , Pancreatitis/blood , Pancreatitis/diagnosis , Plasmapheresis , Reverse Transcriptase Inhibitors/therapeutic use , Tenofovir , Tomography, X-Ray Computed , Triglycerides/bloodABSTRACT
Severe falciparum malaria is a medical emergency that is associated with a high rate of mortality, even when treated in an Intensive Care Unit. Until recently, intravenous quinine was the standard treatment; however, artemisin derivatives are now regarded as the first-line treatment for multidrug-resistant falciparum malaria. Although several studies have demonstrated the superiority of Artesunate, this drug is not licensed in many countries. This article describes the case of an HIV-positive patient, who returned from Africa and presented with 10% parasitemia and clinical signs of severe falciparum malaria; this individual was successfully treated with a combination of artesunate and quinine. Artesunate was imported from the foreign market, and written consent for its administration was obtained in advance. Parasite clearance was rapidly achieved; however, on day IV, the patient developed acute respiratory distress syndrome that required mechanical ventilation. The patient was extubated on day XIV and discharged on day XXV. Due to its rapid action, artesunate was likely responsible for the good clinical outcome in this case; however, in order to clarify the role of this new combination therapy, further studies are required.
