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Amelie and her HIV Infection


Amelie and her HIV Infection


حالة سريرية

الوصف الكامل Background
Amelie is a 12 year-old girl vertically infected with HIV.
She is currently being treated with Combivir (lamivudine/zidovudine) and Kaletra (lopenivir/ritonavir).
الشكوى الرئيسية CC
She presents in clinic today with vomiting, loss of appetite and fever.
الفحص السريري Clinical Exam
On physical examination you note some peri-umbilical pain but no guarding or rebound. She also complains of right shoulder pain. Bowel sounds are normal
الاستقصاءات Investigations
Laboratory studies reveal the following:

Electrolytes, creatinine, and blood urea nitrogen are all normal; liver enzymes, bilirubin, triglycerides and cholesterol are mildly elevated; amylase 163 U/L (normal 5-15 U/L), lipase 4067 U/L (normal 15-110 U/L); urine chemistry and microscopy are normal

An abdominal ultrasound shows a mildly enlarged pancreas with decrease echogenicity.

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What is your diagnosis?
المرجع

.

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acute pancreatitis

Al Durra's picture
Al Durra
بعد التخرج

Pancreatitis is most likely causing Amelie’s symptoms. Pancreatitis has been associated with several of the antiretroviral medications including ritonovir, lamivudine, stavudine, and didanosine. Both serum amylase and lipase should be obtained, as oftentimes HIV-infected patients will have an elevated amylase secondary to inflammation of the salivary glands. Serum lipase is more specific than amylase for acute inflammatory pancreatic disease, and should be obtained when pancreatitis is suspected. An abdominal ultrasound and CT are recommended as well for definitive diagnosis

Pancreatitis in HIV-infected patients also can be associated with opportunistic infections such as cytomegalovirus and mycobacterium. Other medications used to treat HIV-infected patients (e.g., trimethoprim-sulfamethoxazole, pentamidine) also can cause pancreatitis.

The treatment of pancreatitis includes relieving pain, resting the bowel, and restoring metabolic homeostasis. Surgical treatment is not required. If the episode is thought to be associated with antiretroviral medications, a re-challenge of medications is not advised. Children with uncomplicated acute pancreatitis usually do well and recover in less than a week.

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