Acute pancreatitis in children complicating dyslipidemias: a rare entity in pediatrics

Background: Acute pancreatitis (AP) in children is an uncommon but increasingly recognized medical condition, with dyslipidemias, especially severe hypertriglyceridemia, being a rare etiology. The correlation between primary lipid disorders and AP is rarely documented in pediatrics.

Objective: To outline three pediatric cases of acute pancreatitiscomplicated severe hypertriglyceridemia, emphasizing the challenges in diagnosis, treatment approaches, and outcome.

Cases: Case 1: A 40-day-old infant with consanguineous parents who was exclusively breastfed showed signs of vomiting and distension in the abdomen. Laboratory analyses indicated triglycerides at 15.6 g/L and lipase at six times the upper limit of normal. Imaging confirmed Balthazar stage C pancreatitis. Management through fasting and intravenous fluids showed clinical improvement. Case 2: A 2-month-old baby had a fever and was vomiting. The lipid panel showed triglycerides at 25.24 g/L, which is a sign of familial hypertriglyceridemia (type IV). The lipase level was high at 498 IU/L, and an ultrasound showed infiltration around the pancreas. Supportive management improved symptoms, but high triglyceride levels required changes in diet and the introduction of fibrates at 2 years of age. Case 3: A 12-year-old with a history of dyslipidemia and recurrent pancreatitis was hospitalized for an episode. Triglycerides rose to 35 g/L, and the lipase level was high. A CT scan showed Balthazar stage C pancreatitis. Treatment included fasting, a special diet, fibrates, and omega-3. The patient had five recurrent episodes over 24 months, despite a brief improvement, primarily as a result of inadequate dietary adherence.

Conclusion: These cases reflect that, even though severe hypertriglyceridemia is uncommon in children, it should be considered when making a differential diagnosis of acute pancreatitis, especially if lactescent serum is observed. Age-related dietary limitations and long-term adherence make management challenging.

Keywords: acute pancreatitis, hypertriglyceridemia, dyslipidemia, pediatrics.